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Gray KD, Saha S, Battarbee AN, Cotten CM, Boghossian NS, Walsh MC, Greenberg RG. Outcomes of Moderately Preterm Infants of Insulin-Dependent Diabetic Mothers. Am J Perinatol 2024; 41:1212-1222. [PMID: 35299277 PMCID: PMC10369370 DOI: 10.1055/a-1801-3050] [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] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Little is known about the hospital outcomes of moderately preterm (MPT; 29 0/7-33 6/7 weeks gestational age) infants born to insulin-dependent diabetic mothers (IDDMs). We evaluated characteristics and outcomes of MPT infants born to IDDMs compared with those without IDDM (non-IDDM). STUDY DESIGN Cohort study of infants from 18 centers included in the MPT infant database from 2012 to 2013. We compared characteristics and outcomes of infants born to IDDMs and non-IDDMs. RESULTS Of 7,036 infants, 527 (7.5%) were born to IDDMs. Infants of IDDMs were larger at birth, more often received continuous positive pressure ventilation in the delivery room, and had higher risk of patent ductus arteriosus (adjusted relative risk or aRR: 1.49, 95% confidence interval [CI]: 1.20-1.85) and continued hospitalization at 40 weeks postmenstrual age (aRR: 1.55, 95% CI: 1.18-2.05). CONCLUSION MPT infants of IDDM received more respiratory support and prolonged hospitalizations, providing further evidence of the important neonatal health consequences of maternal diabetes. KEY POINTS · Little data are available on moderate preterm infants of IDDMs.. · MPT infants of IDDMs need more respiratory support.. · Longer neonatal intensive care unit stays among MPT infants of IDDMs..
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Affiliation(s)
- Keyaria D. Gray
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - Shampa Saha
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina
| | - Ashley N. Battarbee
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Nansi S. Boghossian
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Michele C. Walsh
- Department of Pediatrics, Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Rachel G. Greenberg
- Department of Pediatrics, Duke University, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
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Patel S, Martel-Bucci A, Wintermark P, Shalish W, Claveau M, Beltempo M. Optimizing timing and frequency of head ultrasound screening for severe brain injury among preterm infants born <32 weeks' gestation. J Matern Fetal Neonatal Med 2022; 35:10330-10336. [PMID: 36216353 DOI: 10.1080/14767058.2022.2128647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To develop a head ultrasound (HUS) screening protocol for infants born <32 weeks gestational age (GA) that accurately identifies severe brain injury (SBI) while minimizing resource use. STUDY DESIGN Retrospective cohort study of infants born <32 weeks GA, admitted to a level 3 neonatal intensive care unit between 2011 and 2017. Timing and results of each HUS were reviewed. SBI was defined as intraventricular hemorrhage grade ≥3 and/or periventricular leukomalacia. Logistic regression models were used to identify risk factors and evaluate the predictive value of HUS at different time points during hospitalization. RESULTS Of 651 included infants, 71 (11%) developed SBI. Risk factors for SBI were GA at birth <29 weeks (adjusted odds ratio (aOR) 2.87, 95% confidence interval (CI) 1.50-5.48), vasopressors on admission (aOR 3.08, 95%CI 1.38-6.88) and mechanical ventilation on admission (aOR 2.50, 95%CI 1.33-4.68). Infants were classified into three risk groups based on these risk factors, and combinations of 1-5 HUS time points were evaluated to determine the optimal number and timing of HUS for each group. The optimal number of screening HUS ranged from 1 for low-risk to 2 for high-risk infants. Adopting a screening protocol using the number and timing of HUS optimized by risk group could reduce the total number of HUS performed by 40% and the median number of HUS per infant from 3 (IQR 2-4) to 2 (IQR 1-3) (p < .01). CONCLUSIONS Implementation of a risk factor-based HUS screening protocol can help reduce resource use while maintaining high sensitivity for detecting SBI.
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Affiliation(s)
- Sharina Patel
- McGill University Health Centre Research Institute, Montreal, Canada
| | - Andrea Martel-Bucci
- Department of Pediatrics, Montreal Children's Hospital - McGill University Health Centre, Montreal, Canada
| | - Pia Wintermark
- Department of Pediatrics, Montreal Children's Hospital - McGill University Health Centre, Montreal, Canada
| | - Wissam Shalish
- Department of Pediatrics, Montreal Children's Hospital - McGill University Health Centre, Montreal, Canada
| | - Martine Claveau
- Department of Pediatrics, Montreal Children's Hospital - McGill University Health Centre, Montreal, Canada
| | - Marc Beltempo
- Department of Pediatrics, Montreal Children's Hospital - McGill University Health Centre, Montreal, Canada
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Bell EF, Stoll BJ, Hansen NI, Wyckoff MH, Walsh MC, Sánchez PJ, Rysavy MA, Gabrio JH, Archer SW, Das A, Higgins RD. Contributions of the NICHD neonatal research network's generic database to documenting and advancing the outcomes of extremely preterm infants. Semin Perinatol 2022; 46:151635. [PMID: 35835615 PMCID: PMC9529835 DOI: 10.1016/j.semperi.2022.151635] [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] [Indexed: 11/20/2022]
Abstract
The Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NRN) maintains a database of extremely preterm infants known as the Generic Database (GDB). Begun in 1987, this database now includes more than 91,000 infants, most of whom are extremely preterm (<29 weeks gestation). The GDB has been the backbone of the NRN, providing high quality, prospectively collected data to study the changing epidemiology of extreme prematurity and its outcomes over time. In addition, GDB data have been used to generate hypotheses for prospective studies and to develop new clinical trials by providing information about the numbers and characteristics of available subjects and the expected event rates for conditions and complications to be studied. Since its inception, the GDB has been the basis of more than 200 publications in peer-reviewed journals, many of which have had a significant impact on the field of neonatology.
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Affiliation(s)
- Edward F Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA.
| | - Barbara J Stoll
- Department of Pediatrics, Emory University, Atlanta, GA, USA; Department of Pediatrics, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Nellie I Hansen
- Social, Statistical, and Environmental Sciences Unit, RTI International, Research Triangle Park, NC
| | - Myra H Wyckoff
- Department of Pediatrics, University of Texas Southwestern, Dallas, TX, USA
| | - Michele C Walsh
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Pablo J Sánchez
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Matthew A Rysavy
- Department of Pediatrics, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Jenna H Gabrio
- Social, Statistical, and Environmental Sciences Unit, RTI International, Berkeley, CA, USA
| | - Stephanie W Archer
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Abhik Das
- Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, MD, USA
| | - Rosemary D Higgins
- Office of the Associate VP for Research, Florida Gulf Coast University, Fort Myers, FL, USA
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Abstract
Neurodevelopmental impairment rates remain high among extremely preterm and very low birth weight infants. This review describes the rates of brain injury and neuro-developmental impairment at 2,3 years, early school age, adolescence, and young adulthood for survivors with intraventricular hemorrhage (IVH). Former preterm infants with a history of high-grade IVH are at the greatest risk of adverse neurodevelopmental outcomes. There is variability, however, in definitions of brain injury, methods for assessing brain injury, and definitions of adverse outcomes among multicenter networks. Despite differences in methods described in publications, perinatal grade III-IV intraventricular hemorrhage, post-hemorrhagic hydrocephalus, and white matter injury are consistently associated with increased rates of adverse motor and cognitive outcomes in the first 2,3 years of life, at early school age, in adolescence and early adulthood. Effects of socioeconomic status on outcomes, however, increase with the increasing age of the child. In summary, although preterm survivors of IVH are at an increased risk of adverse outcomes across a lifetime, there is evidence that social and environmental factors contribute to recovery over time.
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Battin MR, Williams SA, Mackey A, Alzaher W, Sorhage A, Stott NS. Neonatal Neuroimaging in Neonatal Intensive Care Graduates Who Subsequently Develop Cerebral Palsy. J Clin Med 2022; 11:jcm11071866. [PMID: 35407475 PMCID: PMC9000159 DOI: 10.3390/jcm11071866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022] Open
Abstract
Cerebral palsy is a common cause of physical disability. The New Zealand Cerebral Palsy Register (NZCPR) was established in 2015 and reports national data. Internationally, an early CP diagnosis has been a focus, with imaging and clinical tools used to enable early accurate detection. Accordingly, guidelines are being developed for New Zealand, including a specific pathway for high-risk neonatal intensive care (NICU) graduates, reflecting the high rate of CP in this group. To inform this work, we reviewed imaging data from a retrospective NICU cohort identified from the NZCPR. In these 140 individuals with CP and a confirmed NICU admission during 2000–2019 inclusive, imaging frequency, modality, and rate of abnormality was determined. Overall, 114 (81.4%) had imaging performed in the NICU, but the frequency and modality used varied by gestational subgroup. For infants born at less than 32 weeks gestation, 53/55 had routine imaging with ultrasound, and IVH was graded as none or mild (grade 1–2) in 35 or severe (grade 3–4) in 18 infants. For the 34 infants born between 32–36 weeks gestation, only 13/19 imaged in the NICU were reported as abnormal. For 51 term-born infants, 41/42 imaged in the NICU with MRI had abnormal results.
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Affiliation(s)
- Malcolm R. Battin
- Newborn Services, Auckland City Hospital, Park Road, Grafton, Auckland 1023, New Zealand
- Correspondence:
| | - Sîan A. Williams
- Liggins Institute, University of Auckland, Park Road, Grafton, Auckland 1142, New Zealand;
| | - Anna Mackey
- New Zealand Cerebral Palsy Register, Starship Child Health, Auckland 1023, New Zealand; (A.M.); (W.A.); (A.S.)
| | - Woroud Alzaher
- New Zealand Cerebral Palsy Register, Starship Child Health, Auckland 1023, New Zealand; (A.M.); (W.A.); (A.S.)
| | - Alexandra Sorhage
- New Zealand Cerebral Palsy Register, Starship Child Health, Auckland 1023, New Zealand; (A.M.); (W.A.); (A.S.)
| | - N. Susan Stott
- Department of Paediatric Orthopaedics, Starship Child Health, Auckland 1023, New Zealand;
- Department of Surgery, University of Auckland, Auckland 1023, New Zealand
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Smyrni N, Koutsaki M, Petra M, Nikaina E, Gontika M, Strataki H, Davora F, Bouza H, Damianos G, Skouteli H, Mastroyianni S, Dalivigka Z, Dinopoulos A, Tzaki M, Papavasiliou A. Moderately and Late Preterm Infants: Short- and Long-Term Outcomes From a Registry-Based Cohort. Front Neurol 2021; 12:628066. [PMID: 33643206 PMCID: PMC7907517 DOI: 10.3389/fneur.2021.628066] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background: While most studies on the association of preterm birth and cerebral palsy (CP) have focused on very preterm infants, lately, attention has been paid to moderately preterm [32 to <34 weeks gestational age (GA)] and late preterm infants (34 to <37 weeks GA). Methods: In order to report on the outcomes of a cohort of moderately and late preterm infants, derived from a population-based CP Registry, a comparative analysis of data on 95 moderately preterm infants and 96 late preterm infants out of 1,016 with CP, was performed. Results: Moderately preterm neonates with CP were more likely to have a history of N-ICU admission (p = 0.001) and require respiratory support (p < 0.001) than late preterm neonates. Birth weight was significantly related to early neonatal outcome with children with lower birth weight being more likely to have a history of N-ICU admission [moderately preterm infants (p = 0.006)/late preterm infants (p < 0.001)], to require ventilator support [moderately preterm infants (p = 0.025)/late preterm infants (p = 0.014)] and not to have neonatal seizures [moderately preterm infants (p = 0.044)/late preterm infants (p = 0.263)]. In both subgroups, the majority of children had bilateral spastic CP with moderately preterm infants being more likely to have bilateral spastic CP and less likely to have ataxic CP as compared to late preterm infants (p = 0.006). The prevailing imaging findings were white matter lesions in both subgroups, with statistically significant difference between moderately preterm infants who required ventilator support and mainly presented with this type of lesion vs. those who did not and presented with gray matter lesions, maldevelopments or miscellaneous findings. Gross motor function was also assessed in both subgroups without significant difference. Among late preterm infants, those who needed N-ICU admission and ventilator support as neonates achieved worse fine motor outcomes than those who did not. Conclusions: Low birth weight is associated with early neonatal problems in both moderately and late preterm infants with CP. The majority of children had bilateral spastic CP and white matter lesions in neuroimaging. GMFCS levels were comparable in both subgroups while BFMF was worse in late preterm infants with a history of N-ICU admission and ventilator support.
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Affiliation(s)
- Nikoletta Smyrni
- Second Department of Neurology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Maria Koutsaki
- Third Pediatric Department, University General Hospital Attikon, Athens, Greece
| | - Marianna Petra
- Department of Orthopedics, Penteli Children's Hospital, Athens, Greece
| | - Eirini Nikaina
- Department of Pediatrics, Agia Sophia Children's Hospital, Athens, Greece
| | - Maria Gontika
- Department of Neurology, Evaggelismos General Hospital, Athens, Greece
| | - Helen Strataki
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Fotini Davora
- Department of Neurology, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Helen Bouza
- Department of Neonatal Intensive Care Unit, Agia Sophia Children's Hospital, Athens, Greece
| | - George Damianos
- Department of Neurology, Penteli Children's Hospital, Athens, Greece
| | - Helen Skouteli
- Department of Pediatric Neurology, IASO General Hospital, Athens, Greece
| | | | - Zoi Dalivigka
- Rehabilitation Center, Children's Hospital Aglaia Kyriakou, Athens, Greece
| | - Argyris Dinopoulos
- Third Pediatric Department, University General Hospital Attikon, Athens, Greece
| | - Margarita Tzaki
- Neonatal Intensive Care Unit, Elena Venizelou General Hospital, Athens, Greece
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7
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Abstract
Neuroimaging of the preterm infant is a common assessment performed in the NICU. Timely and focused studies can be used for diagnostic, therapeutic, and prognostic information. However, significant variability exists among neonatal units as to which modalities are used and when imaging studies are obtained. Appropriate timing and selection of neuroimaging studies can help identify neonates with brain injury who may require therapeutic intervention or who may be at risk for neurodevelopmental impairment. This clinical report reviews the different modalities of imaging broadly available to the clinician. Evidence-based indications for each modality, optimal timing of examinations, and prognostic value are discussed.
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Affiliation(s)
- Ivan L Hand
- Department of Pediatrics, New York City Health + Hospitals/Kings County, State University of New York Downstate Medical Center, Brooklyn, New York;
| | - Renée A Shellhaas
- Pediatric Neurology Division, Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, Michigan; and
| | - Sarah S Milla
- Departments of Radiology and Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
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8
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Stenzel M, Stüwe‐Kunz L, Bührer C, Roll C. Spontaneous hypocarbia without mechanical ventilation in preterm infants with cystic periventricular leukomalacia. Acta Paediatr 2020; 109:2292-2298. [PMID: 32068917 DOI: 10.1111/apa.15235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 11/29/2022]
Abstract
AIM Hypocarbia induced by mechanical ventilation has been considered a main cause of cystic periventricular leukomalacia (cPVL). However, hypocarbia may occur spontaneously in response to intracellular metabolic acidosis. We aimed to assess whether hypocarbia is more common during mechanical respiratory support than during spontaneous ventilation in infants with cPVL. METHOD In this single-centre, retrospective chart analysis, we compared partial pressure of carbon dioxide (pCO2 ) during the first 96 hours of life in infants with cPVL during endotracheal mechanical ventilation, non-invasive respiratory support, or without respiratory support. RESULTS Cystic periventricular leukomalacia was diagnosed in 23 infants born between 2006 and 2017. Gestational age was 24 weeks in two infants and ranged between 28 and 32 weeks in 21 infants. In these 21 infants, pCO2 less than 35 mm Hg during the first 96 ours of life accounted for 9/60 (15%) measurements during endotracheal mechanical ventilation, 16/116 (14%) during non-invasive respiratory support and 14/42 (33%) in infants without respiratory support (P = .014). CONCLUSION In our series of infants with cPVL, hypocarbia was more common without respiratory support than during endotracheal mechanical ventilation and non-invasive respiratory support. This would suggest that hypocarbia is a symptom rather than a cause of cPVL in these infants.
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Affiliation(s)
- Melanie Stenzel
- Department of Neonatology Paediatric Intensive Care and Sleep Medicine Vestische Kinder‐ und Jugendklinik Datteln University Witten/Herdecke Datteln Germany
| | - Laura Stüwe‐Kunz
- Department of Neonatology Paediatric Intensive Care and Sleep Medicine Vestische Kinder‐ und Jugendklinik Datteln University Witten/Herdecke Datteln Germany
| | - Christoph Bührer
- Department of Neonatology Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Claudia Roll
- Department of Neonatology Paediatric Intensive Care and Sleep Medicine Vestische Kinder‐ und Jugendklinik Datteln University Witten/Herdecke Datteln Germany
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Boswinkel V, Nijboer-Oosterveld J, Nijholt IM, Edens MA, Mulder-de Tollenaer SM, Boomsma MF, de Vries LS, van Wezel-Meijler G. A systematic review on brain injury and altered brain development in moderate-late preterm infants. Early Hum Dev 2020; 148:105094. [PMID: 32711341 DOI: 10.1016/j.earlhumdev.2020.105094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To provide a systematic review of brain injury and altered brain development in moderate-late preterm (MLPT) infants as compared to very preterm and term infants. STUDY DESIGN A systematic search in five databases was performed in January 2020. Original research papers on incidence of brain injury and papers using quantitative data on brain development in MLPT infants were selected. The Johanna Briggs Institute 'Critical Appraisal Checklist for Studies Reporting Prevalence Data' was used for quality appraisal. Data extraction included: imaging modality, incidences of brain injury, brain volumes, 2D-measurements and diffusivity values. RESULTS In total, 24 studies were eligible. Most studies had a moderate quality. Twenty studies reported on the incidence of brain injury in MLPT infants. The incidence of intraventricular hemorrhage (IVH) ranged from 0.0% to 23.5% and of white matter injury (WMI) from 0.5% to 10.8%. One study reported the incidence of arterial infarction (0.3%) and none of cerebellar hemorrhage. Eleven studies compared incidences of brain injury between MLPT infants and very preterm or term infants. Five studies reported signs of altered brain development in MLPT infants. CONCLUSIONS The incidences of IVH and WMI in MLPT infants varied widely between studies. Other abnormalities were sparsely reported. Evidence regarding a higher or lower incidence of brain injury in MLPT infants compared to very preterm or term infants is weak due to moderate methodological quality of reported studies. There is limited evidence suggesting a difference in brain development between MLPT and term infants.
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Affiliation(s)
- Vivian Boswinkel
- Department of Neonatology, Isala Women and Children's hospital, Zwolle, the Netherlands; University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands.
| | | | - Ingrid M Nijholt
- Department of Radiology, Isala hospital, Zwolle, the Netherlands
| | - Mireille A Edens
- Department of Innovation and Science, Isala hospital, Zwolle, the Netherlands
| | | | | | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht, the Netherlands
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Tolia VN, Clark RH, Ellsbury DL, Ho T, Zupancic JAF, Ahmad K. Ten-year trends in infant neuroimaging from US Neonatal Intensive Care Units. J Perinatol 2020; 40:1389-1393. [PMID: 32327710 DOI: 10.1038/s41372-020-0667-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/12/2020] [Accepted: 03/31/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To identify patterns of neuroimaging (NI), including cranial ultrasounds (CUS) and magnetic resonance imaging (MRI), among a large cohort of United States NICU infants. STUDY DESIGN The retrospective cohort study of the Pediatrix Clinical Data Warehouse for infants discharged between 2008 and 2017. RESULTS From the 863,863 infants during the study period, 204,197 (24%) had at least one NI study. CUS was the most common study (n = 189,190, 22%) followed by MRI (n = 37,107, 4%). From 2008 to 2017, the percentage of infants who underwent any NI decreased from 28 to 21% (p < 0.001) driven primarily by a reduction in CUS. MRI use for infants ≤33 weeks increased through 2015 and then decreased. CONCLUSIONS Overall reductions in NI have been driven by decreased use of CUS in infants born at 31-33 weeks' gestational age. MRI use among preterm infants has been more dynamic with an initial rise and recent decrease.
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Affiliation(s)
- Veeral N Tolia
- Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Dallas, TX, USA. .,Pediatrix Medical Group, Dallas, TX, USA. .,The Center for Research Education, Quality, and Safety, Mednax, Inc, Sunrise, FL, USA.
| | - Reese H Clark
- The Center for Research Education, Quality, and Safety, Mednax, Inc, Sunrise, FL, USA
| | - Dan L Ellsbury
- The Center for Research Education, Quality, and Safety, Mednax, Inc, Sunrise, FL, USA
| | - Timmy Ho
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - John A F Zupancic
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kaashif Ahmad
- The Center for Research Education, Quality, and Safety, Mednax, Inc, Sunrise, FL, USA.,Department of Pediatrics, Baylor College of Medicine, San Antonio, TX, USA.,Pediatrix Medical Group, San Antonio, TX, USA
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11
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Lucke AM, Hagan JL, Weiss MD. Does ventriculomegaly without hemorrhage impact neurologic and behavioral outcomes of premature neonates? J Perinatol 2019; 39:1577-1580. [PMID: 31488905 DOI: 10.1038/s41372-019-0492-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/20/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Ashley M Lucke
- Department of Pediatrics, Children's National Medical Center, George Washington University School of Medicine, Washington, DC, USA.
| | - Joseph L Hagan
- Department of Pediatrics (Neonatology), Baylor College of Medicine, Houston, TX, USA
| | - Michael D Weiss
- Department of Pediatrics (Neonatology), University of Florida, Gainesville, FL, USA
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12
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Predictors of Severe Neurologic Injury on Ultrasound Scan of the Head and Risk Factor-based Screening for Infants Born Preterm. J Pediatr 2019; 214:27-33.e3. [PMID: 31377043 DOI: 10.1016/j.jpeds.2019.06.065] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/08/2019] [Accepted: 06/26/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To identify risk factors for severe neurologic injury (intraventricular hemorrhage grade 3 or greater and/or periventricular leukomalacia) diagnosed by ultrasound scan of the head among infants born at 300-326 weeks of gestation and compare different screening strategies. STUDY DESIGN This was a retrospective cohort study of infants born at 300-326 weeks or >326 weeks of gestation with a birth weight <1500 g admitted to neonatal intensive care units in the Canadian Neonatal Network from 2011 to 2016. Stepwise logistic regression analysis was used to identify significant risk factors and calculate aORs and 95% CIs. Risk factor-based screening strategies were compared. RESULTS The rate of severe neurologic injury was 3.1% among infants screened (285/9221). Significant risk factors included singleton birth (aOR 1.96, 95% CI 1.35-2.85), 5-minute Apgar <7 (aOR 1.81, 95% CI 1.30-2.50), mechanical ventilation on day 1 (aOR 2.65, 95% CI 1.88-3.71), and treatment with vasopressors on day 1 (aOR 3.23, 95% CI 2.19-4.75). Risk categories were low (no risk factor, 1.2%, 25/2137), moderate (singleton with no other risk factor: 1.8%, 68/3678), and high (≥1 risk factor among 5-minute Apgar <7, receipt of vasopressors or mechanical ventilation on day 1: 5.6%, 192/3408). Screening moderate- to high-risk infants identified 91% (260/285) of infants with severe neurologic injury and would require screening fewer infants (1647 infants per year) than screening all infants <33 weeks of gestation (2064 infants screened per year, 93% [265/285] of cases identified). CONCLUSIONS Risk factor-based ultrasound scan of the head screening among infants born at 30-32 weeks of gestation could help optimize resources better than gestational age based screening.
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