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Seppänen AV, Barros H, Draper ES, Petrou S, Andronis L, Kim S, Maier RF, Pedersen P, Gadzinowski J, Pierrat V, Sarrechia I, Lebeer J, Ådén U, Toome L, Thiele N, van Heijst A, Cuttini M, Zeitlin J. Variation in follow-up for children born very preterm in Europe. Eur J Public Health 2024; 34:91-100. [PMID: 37978865 PMCID: PMC10843937 DOI: 10.1093/eurpub/ckad192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Children born very preterm (<32 weeks of gestation) face high risks of neurodevelopmental and health difficulties compared with children born at term. Follow-up after discharge from the neonatal intensive care unit is essential to ensure early detection and intervention, but data on policy approaches are sparse. METHODS We investigated the characteristics of follow-up policy and programmes in 11 European countries from 2011 to 2022 using healthcare informant questionnaires and the published/grey literature. We further explored how one aspect of follow-up, its recommended duration, may be reflected in the percent of parents reporting that their children are receiving follow-up services at 5 years of age in these countries using data from an area-based cohort of very preterm births in 2011/12 (N = 3635). RESULTS Between 2011/12 and 22, the number of countries with follow-up policies or programmes increased from 6 to 11. The policies and programmes were heterogeneous in eligibility criteria, duration and content. In countries that recommended longer follow-up, parent-reported follow-up rates at 5 years of age were higher, especially among the highest risk children, born <28 weeks' gestation or with birthweight <1000 g: between 42.1% and 70.1%, vs. <20% in most countries without recommendations. CONCLUSIONS Large variations exist in follow-up policies and programmes for children born very preterm in Europe; differences in recommended duration translate into cross-country disparities in reported follow-up at 5 years of age.
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Affiliation(s)
- Anna-Veera Seppänen
- Université de Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Paediatric Epidemiology Research Team (EPOPé), Paris, France
| | - Henrique Barros
- EPIUnit-Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | | | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lazaros Andronis
- Division of Clinical Trials, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sungwook Kim
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rolf F Maier
- Children’s Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | | | - Janusz Gadzinowski
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Véronique Pierrat
- Université de Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Paediatric Epidemiology Research Team (EPOPé), Paris, France
| | - Iemke Sarrechia
- Department of Family Medicine & Population Health, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Jo Lebeer
- Department of Family Medicine & Population Health, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Ulrika Ådén
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Liis Toome
- Department of Neonatal and Infant Medicine, Tallinn Children's Hospital, Tallinn, Estonia
- Department of Paediatrics, University of Tartu, Tartu, Estonia
| | - Nicole Thiele
- European Foundation for the Care of Newborn Infants (EFCNI), Munich, Germany
| | - Arno van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Neonatology, Erasmus MC—Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Jennifer Zeitlin
- Université de Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Paediatric Epidemiology Research Team (EPOPé), Paris, France
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2
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Fuller MG, Lu T, Gray EE, Jocson MAL, Barger MK, Bennett M, Lee HC, Hintz SR. Rural Residence and Factors Associated with Attendance at the Second High-Risk Infant Follow-up Clinic Visit for Very Low Birth Weight Infants in California. Am J Perinatol 2023; 40:546-556. [PMID: 34044453 DOI: 10.1055/s-0041-1729889] [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: 10/21/2022]
Abstract
OBJECTIVE This study was aimed to determine factors associated with attendance at the second high-risk infant follow-up (HRIF) visit (V2) by 20 months of corrected age after a successful first visit (V1), and the impact of rural residence on attendance rates in a statewide population of very low birth weight (VLBW; <1,500 g) infants. STUDY DESIGN Data linked from the California Perinatal Quality of Care Collaborative (CPQCC) Neonatal Intensive Care Unit (NICU) database and CPQCC-California Children's Services (CCS) HRIF database. Multivariable logistic regression evaluated independent associations of sociodemographic, maternal, family, neonatal clinical, and individual HRIF program differences (factors) with successful V2 in VLBW infants born in 2010 to 2012. RESULTS Of 7,295 eligible VLBW infants, 75% (5,475) attended V2. Sociodemographic factors independently associated with nonattendance included maternal race of Black (adjusted odds ratio [aOR] = 0.61; 95% confidence interval [CI]: 0.5-0.75), public insurance (aOR = 0.79; 95% CI: 0.69-0.91), and rural residence (aOR = 0.74; 95% CI: 0.61-0.9). Factors identified at V1that were associated with V2 attendance included attending V1 within the recommended window (aOR = 2.34; 95% CI: 1.99-2.75) and early intervention enrollment (aOR = 1.39; 95% CI: 1.12-1.61). Neonatal factors associated with attendance included birth weight ≤750 g (aOR = 1.83; 95% CI: 1.48-2.5). There were significant program differences with risk-adjusted rates ranging from 43.7 to 99.7%. CONCLUSION Sociodemographic disparities and HRIF program factors are associated with decreased attendance at V2 among VLBW infants. These findings highlight opportunities for quality and process improvement interventions starting in the NICU and continuing through transition to home and community to assure participation in HRIF. KEY POINTS · Only 75% of VLBW infants attended the second HRIF visit.. · Those less likely to attend were Black or had rural residence.. · Infants in early intervention or attending first visit within recommended ages were more likely to attend..
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Affiliation(s)
- Martha G Fuller
- Hahn School of Nursing and Health Science, University of San Diego, San Diego, California
| | - Tianyao Lu
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- California Perinatal Quality of Care Collaborative, Stanford, California
| | - Erika E Gray
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- California Perinatal Quality of Care Collaborative, Stanford, California
| | - Maria A L Jocson
- Department of Health Care Services, California Children's Services, Integrated Systems of Care, Sacramento, California
| | - Mary K Barger
- Hahn School of Nursing and Health Science, University of San Diego, San Diego, California
| | - Mihoko Bennett
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- California Perinatal Quality of Care Collaborative, Stanford, California
| | - Henry C Lee
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- California Perinatal Quality of Care Collaborative, Stanford, California
| | - Susan R Hintz
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- California Perinatal Quality of Care Collaborative, Stanford, California
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3
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Rodriguez SH, Blair MP, Timtim E, Millman R, Si Z, Wroblewski K, Andrews B, Msall ME, Peyton C. Smartphone application links severity of retinopathy of prematurity to early motor behavior in a cohort of high-risk preterm infants. J AAPOS 2023; 27:12.e1-12.e7. [PMID: 36642242 PMCID: PMC10243477 DOI: 10.1016/j.jaapos.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 11/18/2022] [Accepted: 11/25/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE To evaluate the General Movement Assessment (GMA) with the Motor Optimality Score-Revised (MOS-R) as a neurodevelopmental marker in infants with retinopathy of prematurity (ROP). METHODS Infants screened prospectively for ROP were evaluated at 3 months' post-term age using a smartphone application to complete the GMA and MOS-R. Results were analyzed by ROP severity. RESULTS Of 105 enrolled infants, 83 completed the study. Of these, 54 (65%) had any ROP, 32 (39%) had severe ROP, and 13 (16%) had type 1 ROP. The proportion with aberrant GMA was significantly higher in infants with severe ROP (14/32 [44%]) compared with infants who had milder ROP (8/51 [16%]; P = 0.006). Of those with severe ROP, there was no significant difference comparing infants with type 1 ROP treated with bevacizumab (7/13 [54%]) to infants with type 2 ROP without treatment (7/19 [37%]; P = 0.47). Although the presence of any ROP, stage of ROP, and severe ROP each predicted lower MOS-R scores on univariate analyses, only severe bronchopulmonary dysplasia and markers of brain injury remained significant in the multivariate analysis. CONCLUSIONS The GMA was a convenient, short-term method of data collection with low attrition. Although severe ROP initially appeared linked to poor early motor scores, this association is likely confounded by neurological and respiratory complications, which frequently accompany severe ROP.
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Affiliation(s)
| | - Michael P Blair
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois; Retina Consults Ltd, Des Plaines, Illinois
| | - Elise Timtim
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois
| | - Ryan Millman
- Department of Physical Therapy and Human Movement Science, Northwestern University
| | - Zhuangjun Si
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois
| | | | - Bree Andrews
- Department of Pediatrics, Section of Neonatology, University of Chicago
| | - Michael E Msall
- Department of Pediatrics, Section of Developmental and Behavioral Pediatrics and Kennedy Research Center on Neurodevelopmental Disabilities, University of Chicago, Chicago, Illinois
| | - Colleen Peyton
- Department of Physical Therapy and Human Movement Science, Northwestern University
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4
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Salverda HH, Oldenburger NNJ, Rijken M, Tan RRNGB, Pas ABT, van Klink JMM. Automated oxygen control for very preterm infants and neurodevelopmental outcome at 2 years-a retrospective cohort study. Eur J Pediatr 2023; 182:1593-1599. [PMID: 36693993 PMCID: PMC10167103 DOI: 10.1007/s00431-023-04809-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 01/26/2023]
Abstract
UNLABELLED Faster resolution of hypoxaemic or hyperoxaemic events in preterm infants may reduce long-term neurodevelopmental impairment. Automatic titration of inspiratory oxygen increases time within the oxygen saturation target range and may provide a more prompt response to hypoxic and hyperoxic events. We assessed routinely performed follow-up at 2 years of age after the implementation of automated oxygen control (AOC) as standard care and compared this with a historical cohort. Neurodevelopmental outcomes at 2 years of age were compared for infants born at 24-29 weeks gestational age before (2012-2015) and after (2015-2018) the implementation of AOC as standard of care. The primary outcome was a composite outcome of either mortality or severe neurodevelopmental impairment (NDI), and other outcomes assessed were mild-moderate NDI, Bayley-III composite scores, cerebral palsy GMFCS, and CBCL problem behaviour scores. A total of 289 infants were included in the pre-AOC epoch and 292 in the post-AOC epoch. Baseline characteristics were not significantly different. Fifty-one infants were lost to follow-up (pre-AOC 6.9% (20/289), post-implementation 10.6% (31/292). The composite outcome of mortality or severe NDI was observed in 17.9% pre-AOC (41/229) vs. 24.0% (47/196) post-AOC (p = 0.12). No significant differences were found for the secondary outcomes such as mild-moderate NDI, Bayley-III composite scores, cerebral palsy GMFCS, and problem behaviour scores, with the exception of parent-reported readmissions until the moment of follow-up which was less frequent post-AOC than pre-AOC. CONCLUSION In this cohort study, the implementation of automated oxygen control in our NICU as standard of care for preterm infants led to no statistically significant difference in neurodevelopmental outcome at 2 years of age. WHAT IS KNOWN • Neurodevelopmental outcome is linked to hypoxemia, hyperoxaemia and choice of SpO2 target range. • Automated titration of inspired oxygen may provide a faster resolution of hypoxaemic and hyperoxaemic events. WHAT IS NEW • This cohort study did not find a significant difference in neurodevelopmental outcome at two years of age after implementing automated oxygen control as standard of care.
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Affiliation(s)
- Hylke H Salverda
- Department of Paediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center, PO Box 9600, Leiden, the Netherlands.
| | - N Nathalie J Oldenburger
- Department of Paediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center, PO Box 9600, Leiden, the Netherlands
| | - Monique Rijken
- Department of Paediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center, PO Box 9600, Leiden, the Netherlands
| | - R Ratna N G B Tan
- Department of Paediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center, PO Box 9600, Leiden, the Netherlands
| | - Arjan B Te Pas
- Department of Paediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center, PO Box 9600, Leiden, the Netherlands
| | - Jeanine M M van Klink
- Department of Paediatrics, Division of Psychology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
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Seppänen AV, Draper ES, Petrou S, Barros H, Aubert AM, Andronis L, Kim SW, Maier RF, Pedersen P, Gadzinowski J, Lebeer J, Ådén U, Toome L, van Heijst A, Cuttini M, Zeitlin J. High Healthcare Use at Age 5 Years in a European Cohort of Children Born Very Preterm. J Pediatr 2022; 243:69-77.e9. [PMID: 34921871 DOI: 10.1016/j.jpeds.2021.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/21/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To describe parent-reported healthcare service use at age 5 years in children born very preterm and investigate whether perinatal and social factors and the use of very preterm follow-up services are associated with high service use. STUDY DESIGN We used data from an area-based cohort of births at <32 weeks of gestation from 11 European countries, collected from birth records and parental questionnaires at 5 years of age. Using the published literature, we defined high use of outpatient/inpatient care (≥4 sick visits to general practitioners, pediatricians, or nurses, ≥3 emergency room visits, or ≥1 overnight hospitalization) and specialist care (≥2 different specialists or ≥3 visits). We also categorized countries as having either a high or a low rate of children using very preterm follow-up services at age 5 years. RESULTS Overall, 43% of children had high outpatient/inpatient care use and 48% had high specialist care use during the previous year. Perinatal factors were associated with high outpatient/inpatient and specialist care use, with a more significant association with specialist services. Associations with intermediate parental educational level and unemployment were stronger for outpatient/inpatient services. Living in a country with higher rates of very preterm follow-up service use was associated with lower use of outpatient/inpatient services. CONCLUSIONS Children born very preterm had high healthcare service use at age 5 years, with different patterns for outpatient/inpatient and specialist care by perinatal and social factors. Longer follow-up of children born very preterm may improve care coordination and help avoid undesirable health service use.
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Affiliation(s)
- Anna-Veera Seppänen
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, Center of Research in Epidemiology and Statistics, Université de Paris, INSERM, INRAE, Paris, France.
| | - Elizabeth S Draper
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Henrique Barros
- Epidemiology Research Unit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Adrien M Aubert
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, Center of Research in Epidemiology and Statistics, Université de Paris, INSERM, INRAE, Paris, France
| | - Lazaros Andronis
- Division of Clinical Trials, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Sung Wook Kim
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rolf F Maier
- Department of Neonatology, Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | | | - Janusz Gadzinowski
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jo Lebeer
- Department of Family Medicine & Population Health, Disability Studies, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Ulrika Ådén
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Liis Toome
- Department of Neonatal and Infant Medicine, Tallinn Children's Hospital, Tallinn, Estonia; Department of Pediatrics, University of Tartu, Tartu, Estonia
| | - Arno van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Jennifer Zeitlin
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, Center of Research in Epidemiology and Statistics, Université de Paris, INSERM, INRAE, Paris, France
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6
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[Evidence synthesis: evidence-based clinical practice guidelines for monitoring at-risk newbornsSíntese de evidência: diretrizes de prática clínica baseada em evidência para o acompanhamento de recém-nascidos em risco]. Rev Panam Salud Publica 2022; 45:e141. [PMID: 34987557 PMCID: PMC8699031 DOI: 10.26633/rpsp.2021.141] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022] Open
Abstract
Introducción. La Organización Mundial de la Salud recomienda focalizar la atención en el período neonatal, eliminar la mortalidad de causa prevenible y brindar cuidados de calidad. Es esencial conocer cuáles son las condiciones con alta probabilidad de ocurrencia en esa población para monitorearlos de forma sistemática, de modo que se logre su detección temprana; y el abordaje terapéutico y rehabilitación oportunos. Objetivos. Sintetizar las recomendaciones incluidas en las Directrices de práctica clínica basadas en la evidencia para el seguimiento de recién nacidos en riesgo, publicada por la Centro Latinoamericano de Perinatología/Salud de la Mujer y Reproductiva de la Organización Panamericana de la Salud en el 2020, con el fin de presentar las estrategias para el seguimiento de los niños recién nacidos con condiciones de riesgo desde su nacimiento hasta los 2 años. Métodos. Se llevó a cabo una síntesis de la guía y sus recomendaciones. Además, se realizó una búsqueda sistemática en Pubmed, Lilacs, Health Systems Evidence, Epistemonikos y literatura gris de estudios desarrollados en la Región de las Américas, con el fin de identificar barreras, facilitadores y estrategias de implementación. Resultados. Se formularon 21 recomendaciones y 14 puntos de buena práctica que aplican a los recién nacidos con condiciones de riesgo hasta los dos años (prematuros y aquellos con alteraciones adquiridas o congénitas). Se identificaron barreras como la disponibilidad de pruebas de tamización, deficiencias en el sistema de referencia y conocimiento de las recomendaciones para su implementación. Conclusiones. La guía brinda recomendaciones sobre los criterios de egreso, incluidas pruebas de tamizaje; información y apoyo para padres y cuidadores; tamizaje y frecuencia de seguimiento de los niños en riesgo hasta los dos años en la Región de las Américas.
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7
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Vriend E, Leemhuis A, Flierman M, Schie P, Nollet F, Jeukens‐Visser M. Mental health monitoring in parents after very preterm birth. Acta Paediatr 2021; 110:2984-2993. [PMID: 34375472 PMCID: PMC9291782 DOI: 10.1111/apa.16064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/09/2021] [Accepted: 08/06/2021] [Indexed: 11/28/2022]
Abstract
AIM To evaluate parental mental health monitoring during follow-up care for very preterm (VPT) infants, describe symptoms of anxiety and depression and risk factors for mothers and fathers at 1 and 12 months of corrected age. METHODS Parents completed the Hospital Anxiety and Depression Scale (HADS). Psychological symptoms and risk factors were analysed within and between mothers and fathers. RESULTS In 4 years, the monitoring reached 1260 (48%) families. Of these, 693 mothers and 340 fathers (300 couples) completed the HADS twice. At 1 month, 22% and 15% of the mothers and 10% and 9% of the fathers, respectively, reported elevated symptoms of anxiety and depression. At 12 months, these rates were significantly reduced to 14% and 9% for mothers and 5% and 4% for fathers respectively. Within couples, anxiety and depression were positively associated. At 12 months, in 20% of the couples, one or both parents reported elevated symptoms. Risk factors were length of hospital stay, migration background, educational level and employment status. CONCLUSION The mental health of parents of VPT infants improved, but elevated symptoms were still observed in 17% of included families after one year. Acknowledging and remediating parental mental health remain essential during follow-up care.
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Affiliation(s)
- Eline Vriend
- Department of Rehabilitation Medicine, Amsterdam Reproduction and Development Amsterdam UMC University of Amsterdam Amsterdam the Netherlands
| | - Aleid Leemhuis
- Department of Neonatology, Amsterdam Reproduction and Development Emma Children's Hospital Amsterdam UMC University of Amsterdam Amsterdam the Netherlands
| | - Monique Flierman
- Department of Rehabilitation Medicine, Amsterdam Reproduction and Development Amsterdam UMC University of Amsterdam Amsterdam the Netherlands
| | - Petra Schie
- Department of Rehabilitation Medicine, Amsterdam Reproduction and Development Amsterdam UMC University of Amsterdam Amsterdam the Netherlands
| | - Frans Nollet
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences Amsterdam UMC University of Amsterdam Amsterdam the Netherlands
| | - Martine Jeukens‐Visser
- Department of Rehabilitation Medicine, Amsterdam Reproduction and Development Amsterdam UMC University of Amsterdam Amsterdam the Netherlands
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8
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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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9
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Sarda SP, Sarri G, Siffel C. Global prevalence of long-term neurodevelopmental impairment following extremely preterm birth: a systematic literature review. J Int Med Res 2021; 49:3000605211028026. [PMID: 34284680 PMCID: PMC8299900 DOI: 10.1177/03000605211028026] [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] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective Neurodevelopmental impairment (NDI) is a major complication of extreme prematurity. This systematic review was conducted to summarize the worldwide long-term prevalence of NDI associated with extreme prematurity. Methods Embase and MEDLINE databases were searched for epidemiologic and observational/real-world studies, published in English between 2011 and 2016, reporting long-term prevalence of NDI (occurring from 1 year) among extremely preterm infants born at gestational age (GA) ≤28 weeks. Results Of 2406 articles identified through searches, 69 met the protocol NDI definition (24 North America, 25 Europe, 20 Rest of World). Prevalence of any severity NDI in North America was 8%–59% at 18 months to 2 years, and 11%–37% at 2–5 years; prevalence of moderate NDI in Europe was 10%–13% at 18 months to 2 years, 3% at 2–5 years, and 9%–19% at ≥5 years; prevalence of any NDI in Rest of World was 15%–61% at 18 months to 2 years, and 42% at 2–5 years (no North America/Rest of World studies reported any NDI at ≥5 years). A trend toward higher prevalence of NDI with lower GA at birth was observed. Conclusions Extreme prematurity has a significant long-term worldwide impact on neurodevelopmental outcomes.
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Affiliation(s)
- Sujata P Sarda
- Global Evidence and Outcomes, Takeda, Lexington, MA, USA
| | - Grammati Sarri
- Evidence Synthesis, Modeling & Communication, Evidera, London, UK
| | - Csaba Siffel
- Global Evidence and Outcomes, Takeda, Lexington, MA, USA.,College of Allied Health Sciences, 1421Augusta University, 1421Augusta University, Augusta, GA, USA
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10
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Early developmental screening and intervention for high-risk neonates - From research to clinical benefits. Semin Fetal Neonatal Med 2021; 26:101203. [PMID: 33547000 DOI: 10.1016/j.siny.2021.101203] [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: 11/24/2022]
Abstract
With advances in neonatal care there has been an increase in survival rates for infants born very preterm and/or with complex needs, such as those who require major surgery, who may not have survived decades ago. Despite advances in survival, these infants remain at high-risk for a range of neurodevelopmental delays and/or impairments including motor, cognitive and emotional/behavioural challenges. Research has improved our ability to identify which infants are at high-risk of developmental delay and/or impairments, and there is mounting evidence that early interventions can improve outcomes of these infants. However, clinical practice varies throughout the world regarding recommendations for developmental screening. Moreover, intervention, when available, is often not commenced early enough in development. Given limited resources, those infants most at risk of developmental impairments and their families should be targeted, with further research needed on the cost-effectiveness of surveillance and early interventions.
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Adde L, Brown A, van den Broeck C, DeCoen K, Eriksen BH, Fjørtoft T, Groos D, Ihlen EAF, Osland S, Pascal A, Paulsen H, Skog OM, Sivertsen W, Støen R. In-Motion-App for remote General Movement Assessment: a multi-site observational study. BMJ Open 2021; 11:e042147. [PMID: 33664072 PMCID: PMC7934716 DOI: 10.1136/bmjopen-2020-042147] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 01/21/2021] [Accepted: 02/19/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To determine whether videos taken by parents of their infants' spontaneous movements were in accordance with required standards in the In-Motion-App, and whether the videos could be remotely scored by a trained General Movement Assessment (GMA) observer. Additionally, to assess the feasibility of using home-based video recordings for automated tracking of spontaneous movements, and to examine parents' perceptions and experiences of taking videos in their homes. DESIGN The study was a multi-centre prospective observational study. SETTING Parents/families of high-risk infants in tertiary care follow-up programmes in Norway, Denmark and Belgium. METHODS Parents/families were asked to video record their baby in accordance with the In-Motion standards which were based on published GMA criteria and criteria covering lighting and stability of smartphone. Videos were evaluated as GMA 'scorable' or 'non-scorable' based on predefined criteria. The accuracy of a 7-point body tracker software was compared with manually annotated body key points. Parents were surveyed about the In-Motion-App information and clarity. PARTICIPANTS The sample comprised 86 parents/families of high-risk infants. RESULTS The 86 parent/families returned 130 videos, and 121 (96%) of them were in accordance with the requirements for GMA assessment. The 7-point body tracker software detected more than 80% of body key point positions correctly. Most families found the instructions for filming their baby easy to follow, and more than 90% reported that they did not become more worried about their child's development through using the instructions. CONCLUSIONS This study reveals that a short instructional video enabled parents to video record their infant's spontaneous movements in compliance with the standards required for remote GMA. Further, an accurate automated body point software detecting infant body landmarks in smartphone videos will facilitate clinical and research use soon. Home-based video recordings could be performed without worrying parents about their child's development. TRIALS REGISTRATION NUMBER NCT03409978.
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Affiliation(s)
- Lars Adde
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Annemette Brown
- Department of Health Sciences, Lund University, Lund, Sweden
- Department of Pediatric and Adolescent and Department of Neurology and Physiotherapy, Copenhagen University Hospital, Nordsjællands Hospital, Hillerød, Denmark
| | | | - Kris DeCoen
- Department of Neonatology, University Hospital Ghent, Gent, Belgium
| | - Beate Horsberg Eriksen
- Department of Pediatrics, Møre og Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway
| | - Toril Fjørtoft
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Daniel Groos
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Espen Alexander F Ihlen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Siril Osland
- Clinic of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Aurelie Pascal
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Henriette Paulsen
- Department of Physiotherapy and Rehabilitation, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ole Morten Skog
- Habilitation Center, Vestfold Hospital Trust, Tønsberg, Norway
| | - Wiebke Sivertsen
- Department of Pediatrics, Møre og Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway
| | - Ragnhild Støen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neonatology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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12
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Hwarng GYH, Ereno IL, Ho SKY, Allen JC, Moorakonda RB, Yeo CL. Accuracy of parent-reported ages and stages questionnaire in assessing the motor and language skills of preterm infants. J Neonatal Perinatal Med 2020; 14:193-202. [PMID: 32894254 DOI: 10.3233/npm-200449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Parent-completed tools like the Ages and Stages Questionnaire Third Edition (ASQ-3) are important in developmental screening. As a screening tool, a high negative predictive value (NPV) is critical to avoid missing the diagnosis of developmental delay. This study evaluated the NPV and accuracy of the ASQ-3 in assessing the development of preterm infants. METHODS Infants born at <32 weeks and/or <1250 grams, presenting to the Neonatal Neurodevelopmental Clinic at the Singapore General Hospital for follow-up from January 2014 to June 2017, at 6, 12, and 18 months corrected age, were included. The ASQ-3 and standardized tests - Peabody Developmental Motor Scale-Second Edition (PDMS-2) and Preschool Language Scale, Fourth Edition UK (PLS-4 UK) - were administered. ASQ-3 gross motor and fine motor scores were compared to PDMS-2 at 6 and 12 months, and ASQ-3 communication scores to PLS-4 UK at 18 months. RESULTS At 6 months (n = 145), NPV for gross motor and fine motor were 96.4% (accuracy 80.0%) and 95.4% (accuracy 77.2%) respectively. At 12 months (n = 127), NPV for gross motor and fine motor were 88.9% (accuracy 79.8%) and 82.8% (accuracy 74.0%) respectively. At 18 months (n = 113), NPV for language was 56.9% (accuracy 63.7%). CONCLUSIONS The ASQ-3 showed high NPV and accuracy in screening gross motor and fine motor skills at 6 and 12 months, but not in screening language skills at 18 months. Judicious use of the ASQ-3 may allow for more effective utilization of resources.
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Affiliation(s)
- G Y H Hwarng
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - I L Ereno
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore.,Lee Kong Chian School of Medicine, Singapore
| | - S K Y Ho
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | - C L Yeo
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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13
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Pascal A, Naulaers G, Ortibus E, Oostra A, De Coen K, Michel S, Cloet E, Casaer A, D'haese J, Laroche S, Jonckheere A, Plaskie K, Van Mol C, Delanghe G, Bruneel E, Van Hoestenberghe MR, Samijn B, Govaert P, Van den Broeck C. Neurodevelopmental outcomes of very preterm and very-low-birthweight infants in a population-based clinical cohort with a definite perinatal treatment policy. Eur J Paediatr Neurol 2020; 28:133-141. [PMID: 32788055 DOI: 10.1016/j.ejpn.2020.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND With constant changes in neonatal care practices, recent information is valuable for healthcare providers and for parental counselling. The aim of the study was to describe the neurodevelopmental outcome in a cohort of very preterm (VPT)/very-low-birthweight (VLBW) infants at 2 years corrected age (CA). MATERIAL AND METHODS This is a population-based cohort study of all infants born with a GA <31 weeks and/or BW < 1500 g between 2014 and 2016 admitted to the Flemish (Belgium) neonatal intensive care units. Infants had routine clinical follow-up around 2 years CA. The diagnosis of cerebral palsy (CP), visual and hearing impairments were recorded. Motor, cognitive and language outcomes were assessed using the Bayley-III. Neurodevelopmental impairment (NDI) was classified as mild (<1 standard deviation [SD]) or moderate-severe (<2SD) based on the defined categories of motor, cognitive, hearing, and vision impairments. RESULTS Of the 1941 admissions, 92% survived to discharge and follow-up data were available for 1089 infants (61.1%). Overall, 19.3%, 18.9% and 41.8% of infants had a motor, cognitive and language delay, respectively. CP was diagnosed in 4.3% of the infants. Mild and moderate-to-severe NDI was observed in 25.2% and 10.9% of the infants, respectively. The number of infants with a normal outcome increased from nearly 40% in the category of GA<26 weeks to 70% for infants in the category of 30─31 weeks GA. CONCLUSION At 2 years CA, 64% were free from NDI and 90% were free from moderate-to-severe NDI. However, a lower GA and BW are associated with higher rates of adverse neurodevelopmental outcomes at 2 years CA.
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Affiliation(s)
- Aurelie Pascal
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Department of Development and Regeneration, Katholieke Universiteit Leuven, Herestraat 49, 3000, Leuven, Belgium. http://
| | - Gunnar Naulaers
- Department of Neonatology, University Hospital Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium.
| | - Els Ortibus
- Centre for Developmental Disorders, University Hospital Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium.
| | - Ann Oostra
- Centre for Developmental Disorders, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Kris De Coen
- Department of Neonatology, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Sonnaert Michel
- Department of Neonatology, University Hospital Brussels, Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Eva Cloet
- Department of Pediatric Neurology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Belgium.
| | - Alexandra Casaer
- Department of Neonatology, AZ Sint-Jan, Brugge, Ruddershove 10, 8000, Brugge, Belgium; Centre for Developmental Disorders, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - James D'haese
- Department of Neonatology, AZ Sint-Jan, Brugge, Ruddershove 10, 8000, Brugge, Belgium.
| | - Sabrina Laroche
- Department of Neonatology, University Hospital Antwerp, Wilrijkstraat 10, 2650, Antwerp, Belgium; Centre for Developmental Disorders, University Hospital Antwerp, Wilrijkstraat 10, 2650, Antwerp, Belgium.
| | - An Jonckheere
- Centre for Developmental Disorders, University Hospital Antwerp, Wilrijkstraat 10, 2650, Antwerp, Belgium.
| | - Katleen Plaskie
- Department of Neonatology, GasthuisZusters Antwerpen, Oosterveldlaan 24, Antwerp, Belgium.
| | - Christine Van Mol
- Department of Neonatology, GasthuisZusters Antwerpen, Oosterveldlaan 24, Antwerp, Belgium.
| | - Gwenda Delanghe
- Department of Neonatology, Algemeen Ziekenhuis Middelheim, Lindendreef 1, 2020, Antwerp, Belgium.
| | - Els Bruneel
- Department of Neonatology, Algemeen Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
| | | | - Bieke Samijn
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Paul Govaert
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Christine Van den Broeck
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
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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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15
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Ross GS, Rescorla LA, Perlman JM. Patterns and prediction of behavior problems during the toddler and preschool periods in preterm children. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2020. [DOI: 10.1177/0165025420906467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are few studies of behavior problems in preterm children prior to 2 years old and the changes that occur over time. The aims of this study were to examine the patterns and prediction of behavior problems and the effects of gender and socioeconomic status (SES) on behavior problems in preterm children at the toddler and preschool periods. Parents of 124 very low birthweight preterm children completed a standardized behavior questionnaire at 18 months corrected age and 3 years old. At both times, scores were significantly higher on Attention and Withdrawn Problems than on other behavior problem syndromes. There was a significant overall increase in Externalizing and Internalizing behavior problem scores between 18 months and 3 years, particularly in Internalizing problems. Overall prediction for normal versus not-normal categorization (≥1 standard deviation) on behavior problem and broad-spectrum scales ranged from 77% to 90% and was higher for children in the normal than not-normal categories. Boys had higher Internalizing Problems at 18 months and higher Externalizing Problems at 3 years. Children from low SES families had higher Internalizing and Total Behavior problems at 18 months and higher Internalizing, Externalizing, and Total Behavior problems at 3 years. Screening preterm children for behavior problems before 2 years old appears useful for early intervention of such problems.
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Affiliation(s)
- Gail S. Ross
- Department of Pediatrics, Weill Cornell Medical College, USA
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16
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17
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Kwong AK, Eeles AL, Olsen JE, Cheong JL, Doyle LW, Spittle AJ. The Baby Moves smartphone app for General Movements Assessment: Engagement amongst extremely preterm and term-born infants in a state-wide geographical study. J Paediatr Child Health 2019; 55:548-554. [PMID: 30288823 DOI: 10.1111/jpc.14240] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/26/2018] [Accepted: 09/02/2018] [Indexed: 11/30/2022]
Abstract
AIM The Baby Moves smartphone application is designed for parents to video their infants' spontaneous movement for remote General Movements Assessment (GMA). We aimed to assess the engagement with Baby Moves amongst high- and low-risk infants' families and the socio-demographic variables related to engagement. METHODS Families of extremely preterm (EP; <28 weeks' gestational age) or extremely low-birthweight (ELBW; <1000 g) infants and term-born controls from a state-wide geographical cohort study were asked to download Baby Moves. Baby Moves provided reminders and instructions to capture videos of their infants' general movements. Parents were surveyed about Baby Moves' usability. RESULTS The parents of 451 infants (226 EP/ELBW; 225 control) were recruited; 416 (204 EP/ELBW; 212 control) downloaded Baby Moves, and 346 (158 EP/ELBW; 188 control) returned at least one scorable video for remote GMA. Fewer EP/ELBW families submitted a scorable video than controls (70 vs. 83%, respectively; odds ratio (OR) 0.48, 95% confidence interval (CI) 0.3-0.79, P = 0.003), but the difference diminished when adjusted for socio-demographic variables (OR 1.09, 95% CI 0.59-2.0, P = 0.79). Families who received government financial support (OR 0.28, 95% CI 0.1-0.78, P = 0.015), who spoke limited English at home (OR 0.39, 95% CI 0.22-0.69, P = 0.001) or with lower maternal education (OR 0.38, 95% CI 0.21-0.68, P = 0.001) were less likely to return a scorable video. Surveyed parents responded mostly positively to Baby Moves' usability. CONCLUSIONS Most parents in this study successfully used Baby Moves to capture infant movements for remote GMA. Families of lower socio-demographic status used Baby Moves less.
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Affiliation(s)
- Amanda Kl Kwong
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Victoria, Australia.,Department of Physiotherapy, University of Melbourne, Victoria, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Abbey L Eeles
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Victoria, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Joy E Olsen
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Victoria, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Jeanie Ly Cheong
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Victoria, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - Lex W Doyle
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Victoria, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - Alicia J Spittle
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Victoria, Australia.,Department of Physiotherapy, University of Melbourne, Victoria, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia
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Ibrahim J, Mir I, Chalak L. Brain imaging in preterm infants <32 weeks gestation: a clinical review and algorithm for the use of cranial ultrasound and qualitative brain MRI. Pediatr Res 2018; 84:799-806. [PMID: 30315272 DOI: 10.1038/s41390-018-0194-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 09/21/2018] [Accepted: 09/22/2018] [Indexed: 02/07/2023]
Abstract
The aim is to review the evidence about the utility of term-equivalent age (TEA) magnetic resonance imaging (MRI) in predicting neurodevelopmental outcomes for preterm neonates. Preterm birth accounts for ~12% of all deliveries in the United States and is the leading cause of neurologic disabilities in children. From the neonatologist perspective, it is critically important to identify preterm infants at risk of subsequent neurodevelopmental disability who may benefit from early intervention services. However "the choose wisely campaign" also emphasizes the need to have ongoing cost/benefit discussions regarding care of preterm newborns to avoid waste that comes from subjecting infants to procedures that do not help. We performed a MEDLINE EMBASE database review from 2000 to 2018 to account for the technical evolution in the cranial ultrasound machines and introduction of MRI imaging in the NICU. Studies were graded based on the strength of their design using the GRADE guidelines and summarized with respect to brain MRI vs. cranial US (1) detection of white matter injury; (2) cerebellar hemorrhage; (3) long-term neurodevelopmental outcomes and impact on parental anxiety. We conclude with a hospital-specific guideline algorithm for performing TEA MRI based on risk evaluations ≤32 weeks.
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Affiliation(s)
- John Ibrahim
- University of Texas Southwestern Medical Center Dallas, Dallas, TX, USA
| | - Imran Mir
- University of Texas Southwestern Medical Center Dallas, Dallas, TX, USA
| | - Lina Chalak
- University of Texas Southwestern Medical Center Dallas, Dallas, TX, USA.
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19
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Pascal A, Govaert P, Oostra A, Naulaers G, Ortibus E, Van den Broeck C. Neurodevelopmental outcome in very preterm and very-low-birthweight infants born over the past decade: a meta-analytic review. Dev Med Child Neurol 2018; 60:342-355. [PMID: 29350401 DOI: 10.1111/dmcn.13675] [Citation(s) in RCA: 214] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2017] [Indexed: 11/26/2022]
Abstract
AIM The purpose of this systematic review was to provide an up-to-date global overview of the separate prevalences of motor and cognitive delays and cerebral palsy (CP) in very preterm (VPT) and very-low-birthweight (VLBW) infants. METHOD A comprehensive search was conducted across four databases. Cohort studies reporting the prevalence of CP and motor or cognitive outcome from 18 months corrected age until 6 years of VPT or VLBW infants born after 2006 were included. Pooled prevalences were calculated with random-effects models. RESULTS Thirty studies were retained, which included a total of 10 293 infants. The pooled prevalence of cognitive and motor delays, evaluated with developmental tests, was estimated at 16.9% (95% confidence interval [CI] 10.4-26.3) and 20.6% (95% CI 13.9-29.4%) respectively. Mild delays were more frequent than moderate-to-severe delays. Pooled prevalence of CP was estimated to be 6.8% (95% CI 5.5-8.4). Decreasing gestational age and birthweight resulted in higher prevalences. Lower pooled prevalences were found with the Third Edition of the Bayley Scales of Infant Development than with the Second Edition. INTERPRETATION Even though neonatal intensive care has improved over recent decades, there is still a wide range of neurodevelopmental disabilities resulting from VPT and VLBW births. However, pooled prevalences of CP have diminished over the years. WHAT THIS PAPER ADDS The Bayley Scales of Infant and Toddler Development, Third Edition reported lower pooled prevalences of motor and cognitive delays than the Second Edition. The pooled prevalence of cerebral palsy in infants born extremely preterm was reduced compared with previous meta-analyses.
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Affiliation(s)
- Aurelie Pascal
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.,Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Paul Govaert
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Ann Oostra
- Center for Developmental Disorders, University Hospital Ghent, Ghent, Belgium
| | - Gunnar Naulaers
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Els Ortibus
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
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Abstract
Infants who graduate from the neonatal intensive care unit, including those infants born preterm and/or with brain injury, are at increased risk of long-term neurodevelopmental impairments. The developmental allied health team, consisting of physical therapy, occupational therapy, and speech pathology, is crucial in early evaluation of gross motor, fine motor, feeding, and language development. Surveillance of neurodevelopment in the first year of life is essential to ensure early detection of specific developmental delays and impairments, and to ensure timely referral for early intervention. Early intervention is not only important in optimizing long-term outcomes for the child, but it also plays an important role in enhancing the parent-child relationship and parental well-being. In this review, we discuss the role of the developmental allied health team in the follow-up of high-risk infants, identify key assessment tools used in early neurodevelopmental surveillance, and provide recommendations regarding referral to intervention programs to optimize child and family outcomes. [Pediatr Ann. 2018;47(4):e165-e171.].
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21
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Mills IS, Doyle LW, Cheong JL, Roberts G. Rates of early intervention services in children born extremely preterm/extremely low birthweight. J Paediatr Child Health 2018; 54:74-79. [PMID: 28800210 DOI: 10.1111/jpc.13668] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/22/2017] [Accepted: 06/28/2017] [Indexed: 11/28/2022]
Abstract
AIM To determine the rates of early intervention (EI) service use in extremely preterm (EP, <28 weeks' gestation) or extremely low birthweight (ELBW, <1000 g) infants between 1991 and 2013, and identify biological or socio-economic factors associated with receiving EI. METHODS Participants comprised consecutive EP or ELBW survivors born in 1991-1992, 1997 or 2005 in Victoria, Australia, and randomly selected, matched term-born controls. The main outcome measure was parent-reported EI participation up to 8 years of age. Neurodevelopmental outcomes and socio-economic risk factors were compared with EI participation to identify associations among the preterm groups. RESULTS The rates of EI were higher in the preterm groups than the control groups overall (odds ratio 4.29, 95% confidence interval 3.28, 5.59, P < 0.001), and the rates of EI rose significantly over time - from 42% in the 1991-1992 preterm cohort to 64% in the 2005 preterm cohort. Among the preterm groups, post-natal corticosteroid therapy, cystic periventricular leukomalacia and surgery in the newborn period were all independently associated with increased odds of receiving EI. Increased severity of disability was associated with higher rates of EI. The majority (95%) of preterm children with a physical impairment received EI, compared with only 73% of children with a cognitive impairment alone. EI participation rates were independent of social risk. CONCLUSION EI participation is high in the EP population, and rates of EI use have increased over time. Contrary to previous reports, social risk factors were not found to be associated with EI use.
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Affiliation(s)
- Ianthe S Mills
- Department of Paediatrics and Neonatology, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Lex W Doyle
- Neonatal Services, Royal Women's Hospital, Melbourne, Victoria, Australia.,Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.,Premature Infant Follow-Up Program, Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jeanie Ly Cheong
- Neonatal Services, Royal Women's Hospital, Melbourne, Victoria, Australia.,Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.,Premature Infant Follow-Up Program, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Gehan Roberts
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Community and Child Health, Royal Children's Hospital, Melbourne, Victoria, Australia.,Population Health, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
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Ahn SH, Kim SA. Assessment of Preterm Infants Using the Bayley-III Scales in Korea. Ann Rehabil Med 2017; 41:843-850. [PMID: 29201824 PMCID: PMC5698672 DOI: 10.5535/arm.2017.41.5.843] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/01/2017] [Indexed: 11/05/2022] Open
Abstract
Objective To assess the well-being of preterm newborns using the Bayley-III scales in a Korean-based population, and to evaluate the perinatal risk factors influencing developmental outcome. Methods Using the Bayley-III scales, we assessed 120 preterm infants who were referred for evaluation of neurodevelopmental performance. We subdivided them into an extremely preterm group (n=18) and a very/moderate to late preterm group (n=102). Bayley-III mean scores and the rate of infants showing a delay were compared for both groups. The relationship between perinatal risk factors and Bayley-III scores was analyzed. The risk factors were considered as very low birth weight, history of neonatal medical problems, and abnormal radiologic findings in brain magnetic resonance images (MRIs). Results Although no significant differences in mean scores were observed between the extremely preterm group and the very/moderate to late preterm group, the rate of babies showing developmental delay in motor composite scores was significantly higher in the extremely preterm group. The proportions of preterm infants with cognitive, language, and motor delays were 38.3%, 26.7%, and 35.0%, respectively. Very low birth weight was a significant risk factor for low cognitive, language, and motor composite scores. Also, abnormal radiologic findings on brain MRI were significant indicators of lower motor composite scores. Conclusion Cognitive development was the most frequently delayed domain in preterm infants and motor development was more frequently delayed in the extremely preterm group. The very low birth weight and abnormal radiologic findings in brain MRI were predictive factors for neurodevelopmental outcome.
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Affiliation(s)
- Sung Ho Ahn
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Soo A Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
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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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Spittle A. Understanding the relationship between behavioural and motor impairments in extremely low birthweight preterm children. Acta Paediatr 2017; 106:526-527. [PMID: 28318125 DOI: 10.1111/apa.13759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Alicia Spittle
- Department of Physiotherapy; The University of Melbourne; Parkville Vic. Australia
- Physiotherapy Department; The Royal Women's Hospital; Parkville Vic. Australia
- Victorian Infant Brain Studies; Murdoch Childrens Research Institute; Parkville Vic. Australia
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Weber P, Depoorter A, Hetzel P, Lemola S. Habituation as Parameter for Prediction of Mental Development in Healthy Preterm Infants: An Electrophysiological Pilot Study. J Child Neurol 2016; 31:1591-1597. [PMID: 27625014 DOI: 10.1177/0883073816665312] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 06/21/2016] [Accepted: 07/24/2016] [Indexed: 11/17/2022]
Abstract
The aim of this prospective pilot study was to evaluate the predictive value of discrimination and habituation, which was measured by mismatch negativity in 17 healthy very preterm (mean gestational age 27.4 weeks; range 25.0-31.3) and 16 term (mean gestational age 40.3 weeks; range 37.9-41.7) born infants at term equivalent age. Developmental outcome was measured by Bayley Scales of Infant Development-I in 13 preterm and 13 term-born children at a mean age of 21.7 months (±2.18) and 18.5 months (±1.9), respectively. No differences in amplitude and latency of the mismatch negativity were found between both groups at term equivalent age. Within the preterm group habituation capacity was positively correlated with the Mental Developmental Index (r = .654, P = .008) and Performance Developmental Index (r = .482, P = .048) at 21 months. Early learning capability, as measured by habituation, may be associated with a better prognosis for early mental development in healthy preterm infants.
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Affiliation(s)
- Peter Weber
- Division of Neuropediatrics & Developmental Medicine, University Children's Hospital, Basel, Switzerland
| | - Antoinette Depoorter
- Division of Neuropediatrics & Developmental Medicine, University Children's Hospital, Basel, Switzerland
| | - Patrick Hetzel
- Division of Neuropediatrics & Developmental Medicine, University Children's Hospital, Basel, Switzerland.,Division of Neonatology, University Children's Hospital, Basel, Switzerland
| | - Sakari Lemola
- Department of Psychology, University of Warwick, Conventry, UK
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Abstract
Prematurity is the leading cause of infant mortality worldwide. In developed countries, extremely preterm infants contribute disproportionately to both neonatal and infant mortality. Survival of this high-risk population has incrementally improved in recent years. Despite these improvements, approximately one in four extremely preterm infants dies during the birth hospitalization. Among those who survive, respiratory and other morbidities are common, although their effect on quality of life is variable. In addition, long-term neurodevelopmental impairment is a large concern for patients, clinicians, and families. However, the interplay of multiple factors contributes to neurodevelopmental impairment, with measures that change over time and outcomes that can be difficult to define and predict. Understanding outcomes of extremely preterm infants can help better counsel families regarding antenatal and postnatal care and guide strategies to improve survival without morbidity. This review summarizes recent evidence to provide an overview into the short- and long-term outcomes for extremely preterm infants.
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Affiliation(s)
- Ravi Mangal Patel
- Division of Neonatology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Neonatology, Children's Healthcare of Atlanta, Atlanta, GA
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