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MacDonald S, Stratas A, Synnes AR, Sandila N, Campbell-Yeo M, Shah PS, Ghotra S. Parent-reported health outcomes at preschool age in preterm survivors: a population-based cohort study. Arch Dis Child Fetal Neonatal Ed 2024; 109:436-442. [PMID: 38135493 DOI: 10.1136/archdischild-2023-326136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE Literature on health status (HS) and health-related quality of life of preterm survivors at preschool age is sparse. Further, little is known about the relationship between parent-reported HS outcomes and standardised neurodevelopmental outcomes measured in preterm survivors at preschool age. Our objective was to evaluate parent-reported child HS outcomes and their relationship to neurodevelopmental outcomes at 36 months of age in very preterm survivors. DESIGN Prospective population-based cohort study. SETTING Perinatal follow-up programme. PATIENTS Infants <31 weeks' gestational age born from 2014 to 2016. OUTCOME MEASURES Parents completed the Health Status Classification System for Pre-School Children questionnaire at 36 months. At the same age, neurodevelopmental assessments were completed to determine neurodevelopmental impairment (NDI). NDI was categorised as none, 'mild' or 'significant' (moderate or severe cerebral palsy, Bayley Scales of Infant and Toddler Development - Third Edition <70, blind or required hearing aid). RESULTS Of 118 children, 87 (73.7%) parents reported their child had an HS concern (mild: 61 (51%); moderate: 16 (13.6%); and severe: 10 (8.5%)). Mild and significant NDIs were observed in 17 (14.4%) and 14 (11.9%) children, respectively. For the 14 (12%) children with significant NDI, 7 (50.0%) parents reported severe and 4 (28.6%) reported moderate concerns. Conversely, for 26 (22%) children with parent-reported moderate to severe concerns, 11 (42.3%) met the criteria for significant NDI. There was a moderate positive correlation between parental concern and NDI status (Spearman correlation=0.46, p<0.0001). CONCLUSIONS Parental HS concerns only moderately correlated with the NDI status. Of the 12% of children with significant NDI, only half of the parents reported severe HS concerns.
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Affiliation(s)
| | | | - Anne R Synnes
- Neonatology, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Navjot Sandila
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Marsha Campbell-Yeo
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Satvinder Ghotra
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
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2
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Abdelmageed WA, Lapointe A, Brown R, Gorgos A, Luu TM, Beltempo M, Altit G, Dayan N. Association between maternal hypertension and infant neurodevelopment in extremely preterm infants. J Perinatol 2024; 44:539-547. [PMID: 38287138 DOI: 10.1038/s41372-024-01886-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/04/2023] [Accepted: 01/16/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVE To examine the association between maternal hypertension during pregnancy and neurodevelopmental impairment (NDI) at 24 months post-menstrual age in extremely preterm infants. STUDY DESIGN Using data from two tertiary neonatal units (2011-2017) for infants born at 23 + 0 to 28 + 6 weeks, we investigated outcomes of NDI related to maternal hypertension and small-for-gestational-age (SGA) status. RESULTS Of 1019 pre-term infants, 647 had complete data and were included in the analysis. Ninety-six (15%) had maternal hypertension exposure; 25 (4%) were also SGA. Infants with maternal hypertension showed a higher odds of any NDI (aOR: 2.29, 95% CI = 1.36-3.87) and significant NDI (aOR: 2.01, 95% CI = 1.02-3.95). The combination of hypertension and SGA further elevated this risk (aOR for any NDI: 4.88, 95% CI = 1.80-13.22; significant NDI: 6.91, 95% CI = 2.50-19.12). CONCLUSION Maternal hypertension during pregnancy elevates the risk of NDI in extremely preterm infants, more so when combined with SGA.
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Affiliation(s)
- Wael A Abdelmageed
- Department of Medicine, Division of Experimental Medicine, McGill University Health Center, Montreal, QC, Canada
| | - Anie Lapointe
- Division of Neonatology, Department of Paediatrics, Sainte-Justine University Hospital Center, Montréal, QC, Canada
| | - Richard Brown
- Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Andreea Gorgos
- Neonatal Follow-Up, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Thuy Mai Luu
- Neonatal Follow-Up, Department of Paediatrics, Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Marc Beltempo
- Division of Neonatology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Gabriel Altit
- Division of Neonatology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Natalie Dayan
- Research Institute, McGill University Health Centre, Montreal, QC, Canada.
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3
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Kiechl-Kohlendorfer U, Simma B, Berger A, Urlesberger B, Wald M, Haiden N, Fuiko R, Ndayisaba JP. Two-year neurodevelopmental outcome in extremely preterm-born children: The Austrian Preterm Outcome Study Group. Acta Paediatr 2024. [PMID: 38433292 DOI: 10.1111/apa.17187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/24/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
AIM The current study determined the neurodevelopmental outcome of extremely preterm infants at 2 years of age. METHODS All live-born infants 23-27 weeks of gestation born between 2011 and 2020 in Austria were included in a prospective registry. Neurodevelopmental outcome at 2 years of corrected age was assessed using Bayley Scales of Infant Development for both motor and cognitive scores, along with a neurological examination and an assessment of neurosensory function. RESULTS 2378 out of 2905 (81.9%) live-born infants survived to 2 years of corrected age. Follow-up data were available for 1488 children (62.6%). Overall, 43.0% had no, 35.0% mild and 22.0% moderate-to-severe impairment. The percentage of children with moderate-to-severe neurodevelopmental impairment decreased with increasing gestational age and was 31.4%, 30.5%, 23.3%, 19.0% and 16.5% at 23, 24, 25, 26 and 27 weeks gestational age (p < 0.001). Results did not change over the 10-year period. In multivariate analysis, neonatal complications as well as male sex were significantly associated with an increased risk of neurodevelopmental impairment. CONCLUSION In this cohort study, a 22.0% rate of moderate-to-severe neurodevelopmental impairment was observed among children born extremely preterm. This national data is important for both counselling parents and guiding the allocation of health resources.
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Affiliation(s)
| | - Burkhard Simma
- Department of Paediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Angelika Berger
- Division of Neonatology, Paediatric Intensive Care and Neuropediatric, Department of Paediatrics and Adolescent Medicine, Comprehensive Centre for Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Berndt Urlesberger
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria
| | - Martin Wald
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Nadja Haiden
- Department of Neonatology, Kepler University Hospital Linz, Linz, Austria
| | - Renate Fuiko
- Division of Neonatology, Paediatric Intensive Care and Neuropediatric, Department of Paediatrics and Adolescent Medicine, Comprehensive Centre for Paediatrics, Medical University of Vienna, Vienna, Austria
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Guillén Ú, Zupancic JAF, Litt JS, Kaempf J, Fanaroff A, Polin RA, Martin R, Eichenwald E, Wilson-Costello D, Edwards AD, Hallman M, Bührer C, Fanaroff J, Albersheim S, Embleton ND, Shah PS, Dennery PA, Discenza D, Jobe AH, Kirpalani H. Community Considerations for Aggressive Intensive Care Therapy for Infants <24+0 Weeks of Gestation. J Pediatr 2024; 268:113948. [PMID: 38336203 DOI: 10.1016/j.jpeds.2024.113948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/20/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Affiliation(s)
| | - John A F Zupancic
- Division of Newborn Medicine, Harvard Medical School, Boston, MA; Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jonathan S Litt
- Division of Newborn Medicine, Harvard Medical School, Boston, MA; Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA
| | - Joseph Kaempf
- Women and Children's Services, Providence St. Vincent Medical Center, Portland, OR
| | - Avroy Fanaroff
- Emeritus, Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Cleveland, OH
| | | | - Richard Martin
- Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Eric Eichenwald
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - A David Edwards
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Mikko Hallman
- Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland
| | - Christoph Bührer
- Department of Neonatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jonathan Fanaroff
- Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Susan Albersheim
- Division of Neonatology, University of British Columbia, Vancouver, BC, Canada
| | | | - Prakesh S Shah
- Division of Neonatology, Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Phyllis A Dennery
- Warren Alpert School of Medicine of Brown University, Providence, RI
| | | | - Alan H Jobe
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, and University of Cincinnati, Cincinnati, OH
| | - Haresh Kirpalani
- Emeritus, Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, and Emeritus Department Pediatrics, McMaster University, Hamilton, ON, Canada
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5
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Diguisto C, Morgan AS, Foix L'Hélias L, Pierrat V, Ancel PY, Cohen JF, Goffinet F. Five-year outcomes for extremely preterm babies with active perinatal management: A clinical prediction model. BJOG 2024; 131:151-156. [PMID: 37592874 DOI: 10.1111/1471-0528.17633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/19/2023] [Accepted: 07/23/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE To develop and validate a clinical prediction model for outcomes at 5 years of age for children born extremely preterm and receiving active perinatal management. DESIGN The EPIPAGE-2 national prospective cohort. SETTING France, 2011. POPULATION Live-born neonates between 24+0 and 26+6 weeks of gestation who received active perinatal management (i.e. birth in a tertiary-level hospital, with antenatal steroids and resuscitation at birth). METHODS A prediction model using logistic modelling, including gestational age, small-for gestational-age (SGA) status and sex, was developed. Model performance was assessed through calibration and discrimination, with bootstrap internal validation. MAIN OUTCOME MEASURES Survival without moderate or severe neurodevelopmental disability (NDD) at 5 years. RESULTS Among the 557 neonates included, 401 (72%) survived to 5 years, of which 59% survived without NDD (95% CI 54% to 63%). Predicted rates of survival without NDD ranged from 45% (95% CI 33% to 57%), to 56% (95% CI 49% to 64%) to 64% (95% CI 57% to 70%) for neonates born at 24, 25 and 26 weeks of gestation, respectively. Predicted rates of survival without NDD were 47% (95% CI 18% to 76%) and 62% (95% CI 49% to 76%) for SGA and non-SGA children, respectively. The model showed good calibration (calibration slope 0.85, 95% CI 0.54 to 1.16; calibration-in-the-large -0.0123, 95% CI -0.25 to 0.23) and modest discrimination (C-index 0.59, 95% CI 0.53 to 0.65). CONCLUSIONS A simple prediction model using three factors easily known antenatally may help doctors and families in their decision-making for extremely preterm neonates receiving active perinatal management.
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Affiliation(s)
- Caroline Diguisto
- Université Paris Cité, Université Sorbonne Paris Nord, Inserm, INRAE, CRESS U1153, EPOPé, Paris, France
- Maternité Olympe de Gouges Centre, Hospitalier Regional Universitaire Tours, Université de Tours, Tours, France
| | - Andrei Scott Morgan
- Université Paris Cité, Université Sorbonne Paris Nord, Inserm, INRAE, CRESS U1153, EPOPé, Paris, France
- Department of Neonatal Medicine, Hôpital Nord, Association Publique Hôpitaux de Marseille, Marseille, France
| | - Laurence Foix L'Hélias
- Université Paris Cité, Université Sorbonne Paris Nord, Inserm, INRAE, CRESS U1153, EPOPé, Paris, France
- Department of Neonatal Paediatrics, Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Veronique Pierrat
- Université Paris Cité, Université Sorbonne Paris Nord, Inserm, INRAE, CRESS U1153, EPOPé, Paris, France
- Department of Neonatology, CHI Créteil, Créteil, France
| | - Pierre-Yves Ancel
- Université Paris Cité, Université Sorbonne Paris Nord, Inserm, INRAE, CRESS U1153, EPOPé, Paris, France
- Clinical Investigation Centre P1419, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérémie F Cohen
- Université Paris Cité, Université Sorbonne Paris Nord, Inserm, INRAE, CRESS U1153, EPOPé, Paris, France
- Department of General Paediatrics and Paediatric Infectious Diseases, Hôpital Necker-Enfants Malades, APHP, Université Paris Cité, Paris, France
| | - Francois Goffinet
- Université Paris Cité, Université Sorbonne Paris Nord, Inserm, INRAE, CRESS U1153, EPOPé, Paris, France
- Maternité Port Royal, Université Paris Cité, Cochin-Broca-Hôtel Dieu Hospitals, Assistance Publique-Hôpitaux de Paris, DHU Risk in Pregnancy, Paris, France
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6
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Huang HB, Hicks M, Zhang QS, Watt MJ, Lin F, Wan XQ, Cheung PY. The differential associative relationship between early risk factors, neonatal morbidities and early neurodevelopmental outcome in preterm infants <29 weeks' gestation. Early Hum Dev 2023; 186:105859. [PMID: 37738923 DOI: 10.1016/j.earlhumdev.2023.105859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/03/2023] [Accepted: 09/10/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Very preterm infants of <29 weeks' gestation are at high risk for adverse neurodevelopment due to multiple risk factors in the early stages of life. There is little information regarding the associative effects of risk factors in early life, neonatal morbidities and subsequent neurodevelopmental outcomes. AIMS Investigate the association of early neurodevelopmental outcomes, neonatal complications and the risk factors in the early hours of life in a cohort of preterm infants <29 weeks' gestational age. METHODS We enrolled all surviving preterm neonates born at gestation <29 weeks between January 2015 and June 2021 in the University of Hong Kong-Shenzhen Hospital. Demographic and clinical characteristics were collected from a database of the neonatal intensive care unit. Neurodevelopmental outcomes of the survivors were evaluated using the Ages and Stages Questionnaire (ASQ-3) which were measured at the adjusted age of 12 to 18 months. The multivariate linear regression model was used to determine correlation presented as β coefficient (β) with 95 % confidence intervals (CI). RESULTS In this cohort of 56 survivors <29 weeks' gestation, urine output within the first 12 h of life and Apgar score at 5 min were positively associated with different domains of ASQ-3 score, however male sex and highest fraction of inspired oxygen (FiO2) in the first 12 h of life were negatively related with at least one of neurocognitive domains of ASQ-3 at adjusted age of 12 to 18 months. During hospitalization, in addition to the frequency of packed red cell transfusions, the development of severe necrotizing enterocolitis was inversely associated with both neuromotor and neurocognitive skills (gross motor domain: β = -16.93, CI: -32.04, -1.82; fine motor domain: β = -16.42, CI: -28.82, -4.02; problem solving domain: β = -13.14, CI: -24.45, -1.83; all P < 0.05), whereas severe intraventricular hemorrhage had adverse effects on gross motor only (β = -13.04, CI: -24.42, -1.65; P = 0.03). Bronchopulmonary dysplasia and retinopathy of prematurity were not related with ASQ-3. CONCLUSIONS In this small cohort study of very preterm neonates born at <29 weeks' gestation, risk factors in the early hours of life and neonatal morbidities during hospitalization had differential associative relationships with ASQ-3 at 12-18 months adjusted age. This information may be important for parental counseling and management including early diagnosis and intervention.
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Affiliation(s)
- Hai-Bo Huang
- Department of Pediatrics, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Matthew Hicks
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Qian-Shen Zhang
- Department of Pediatrics, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Man Joe Watt
- Department of Pediatrics, University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Department of Pediatrics, Glenrose Rehabilitation Hospital, University of Alberta, Edmonton, AB, Canada; Department of Physical Medicine and Rehabilitation, Glenrose Rehabilitation Hospital, University of Alberta, Edmonton, AB, Canada
| | - Fang Lin
- Department of Pediatrics, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xue-Qin Wan
- Department of Pediatrics, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Po-Yin Cheung
- Department of Pediatrics, University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
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7
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Kaempf JW, Guillen U, Litt JS, Zupancic JAF, Kirpalani H. Change in neurodevelopmental outcomes for extremely premature infants over time: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2023; 108:458-463. [PMID: 36270779 DOI: 10.1136/archdischild-2022-324457] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/01/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Survival rates of extremely premature infants are rising, but changes in neurodevelopmental impairment (NDI) rates are unclear. Our objective was to perform a systematic review of intrainstitutional variability of NDI over time. DESIGN Systematic review and meta-analysis. DATA SOURCES Ovid MEDLINE, Embase, PubMed, Cochrane Library and Google Scholar. STUDY SELECTION Study eligibility: (1) at least two discrete cohorts of infants born <27 weeks' gestation or <1000 g birth weight, (2) one cohort born after 1990 and at least one subsequent cohort of similar gestational age, (3) all cohorts cared for within the same Neonatal Intensive Care Unit(s) (NICU) and (4) neurodevelopmental outcomes at 18-36 months corrected age. MAIN OUTCOME Change in NDI rates. Quality, validity and bias were assessed using Grading of Recommendations, Assessment, Development, and Evaluation and Quality in Prognosis Studies guidelines. RESULTS Of 203 publications, 15 were eligible, including 13 229 infants. At the first time point, average NDI rate across study groups weighted by sample size was 41.0% (95% CI 34.0% to 48.0%). The average change in NDI between time points was -3.3% (95% CI -8·8% to 2.2%). For each added week of gestation at birth, the rate of NDI declined by 9.7% (95% CI 6.2% to 13.3%). Most studies exhibited moderate-severe bias in at least one domain, especially attrition rates. CONCLUSIONS When comparing discrete same-centre cohorts over time, there was no significant change in NDI rates in infants born <27 weeks' gestation or <1000 g. Higher survival rates unaccompanied by improvement in neurodevelopment highlight urgency for renewed focus on the causes of NDI and evidence-based strategies to reduce brain injury.
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Affiliation(s)
- Joseph W Kaempf
- Women and Children's Services, Providence Health System, Portland, Oregon, USA
| | - Ursula Guillen
- Division of Neonatology, ChristianaCare, Wilmington, Delaware, USA
| | - Jonathan S Litt
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Division of Newborn Medicine, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - John A F Zupancic
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Division of Newborn Medicine, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Haresh Kirpalani
- Emeritus, Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Emeritus, Division of Neonatology, McMaster University, Hamilton, Massachusetts, Canada
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8
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Synnes A, Chera A, Richter LL, Bone JN, Bourque CJ, Zhang-Jiang S, Pearce R, Janvier A, Luu TM. Redefining Neurodevelopmental Impairment: Perspectives of Very Preterm Birth Stakeholders. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050880. [PMID: 37238428 DOI: 10.3390/children10050880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
Children born very preterm are at risk of severe neurodevelopmental impairment, a composite endpoint that includes cerebral palsy, developmental delay, and hearing and visual impairment defined by medical professionals. We aimed to describe preterm birth stakeholders' perspectives on this classification. Ten clinical scenarios describing 18-month-old children with different components of severe neurodevelopmental impairment and one scenario of a typically developing child (control) were distributed to parents and stakeholders using a snowball sampling technique. For each scenario, participants rated health on a scale from 0 to 10 and whether the scenario represented a severe condition. Results were analyzed descriptively and mean differences from the control scenario were compared using a linear mixed-effects model. Stakeholders (number = 827) completed 4553 scenarios. Median health scores for each scenario varied from 6 to 10. The rating for the cerebral palsy and language delay scenario was significantly lower (mean difference -4.3; 95% confidence interval: -4.4, -4.1) than the control. The proportion of respondents rating a scenario as "severe" ranged from 5% for cognitive delay to 55% for cerebral palsy and language delay. Most participants disagreed with the rating used in research to describe severe neurodevelopmental impairment in preterm children. The term should be redefined to align with stakeholder perceptions.
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Affiliation(s)
- Anne Synnes
- Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Amarpreet Chera
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Lindsay L Richter
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Jeffrey N Bone
- BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | | | - Sofia Zhang-Jiang
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Rebecca Pearce
- Science and Mathematics Education Research Group, Faculty of Education, McGill University, Montreal, QC H3A 0G4, Canada
| | - Annie Janvier
- Department of Pediatrics, Bureau de l'Éthique Clinique (BEC), Université de Montréal, QC H3C 3J7, Canada
- Division of Neonatology, Unité d'Éthique Clinique, Unité de Soins Palliatifs, Bureau du Partenariat Patients-Familles-Soignants, Montréal, QC H3T 1C5, Canada
- Department of Pediatrics, Université de Montréal, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Université de Montréal, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
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9
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Hintz SR, deRegnier RA, Vohr BR. Outcomes of Preterm Infants: Shifting Focus, Extending the View. Clin Perinatol 2023; 50:1-16. [PMID: 36868700 DOI: 10.1016/j.clp.2022.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Advances in perinatal care have led to remarkable long-term survival for infants who are born preterm. This article reviews the broader context of follow-up care, highlighting the need to reenvision some areas, such as improving parental support by embedding parental involvement in the neonatal intensive care unit, incorporating parental perspectives about outcomes into follow-up care models and research, supporting their mental health, addressing social determinants of health and disparities, and advocating for change. Multicenter quality improvement networks allow identification and implementation of best practices for follow-up care.
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Affiliation(s)
- Susan R Hintz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, 453 Quarry Road, 4th Floor, Palo Alto, CA 94304, USA.
| | - Raye-Ann deRegnier
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 45, Chicago, IL 60611, USA
| | - Betty R Vohr
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital, Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI 02905, USA
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10
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Grading of Intraventricular Hemorrhage and Neurodevelopment in Preterm <29 Weeks’ GA in Canada. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121948. [PMID: 36553391 PMCID: PMC9777052 DOI: 10.3390/children9121948] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/01/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
Objective: The aim of this study was to evaluate the neurodevelopmental outcome at 18−24 months in surviving preterm infants with grades I−IV intraventricular hemorrhages (IVHs) compared to those with no IVH. Study Design: We included preterm survivors <29 weeks’ GA admitted to the Canadian Neonatal Network’s NICUs from April 2009 to September 2011 with follow-up data at 18−24 months in a retrospective cohort study. The neonates were grouped based on the severity of the IVH detected on a cranial ultrasound scan and recorded in the database: no IVH; subependymal hemorrhage or IVH without ventricular dilation (grades I−II); IVH with ventricular dilation (grade III); and persistent parenchymal echogenicity/lucency (grade IV). The primary outcomes of neurodevelopmental impairment (NDI), significant neurodevelopmental impairment (sNDI), and the effect modification by other short-term neonatal morbidities were assessed. Using multivariable regression analysis, the adjusted ORs (AOR) and 95% of the CIs were calculated. Results: 2327 infants were included. The odds of NDI were higher in infants with grades III and IV IVHs (AOR 2.58, 95% CI 1.56, 4.28 and AOR 2.61, 95% CI 1.80, 3.80, respectively) compared to those without IVH. Infants with an IVH grade ≤II had similar outcomes for NDI (AOR 1.08, 95% CI 0.86, 1.35) compared to those without an IVH, but the odds of sNDI were higher (AOR 1.58, 95% CI 1.16, 2.17). Conclusions: There were increased odds of sNDI in infants with grades I−II IVHs, and an increased risk of adverse NDI in infants with grades ≥III IVHs is corroborated with the current literature.
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Kilbride HW, Vohr BR, McGowan EM, Peralta-Carcelen M, Stringer K, Das A, Archer SW, Hintz SR. Early neurodevelopmental follow-up in the NICHD neonatal research network: Advancing neonatal care and outcomes, opportunities for the future. Semin Perinatol 2022; 46:151642. [PMID: 35842320 PMCID: PMC11068160 DOI: 10.1016/j.semperi.2022.151642] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
At the inception of the Eunice Kennedy Shriver National Institute of Child Health and Development Neonatal Research Network (NRN), provision of care for extremely preterm (EPT) infants was considered experimental. The NRN Follow-up Study Group, initiated in 1993, developed infrastructure with certification processes and standards, allowing the NRN to assess 2-year outcomes for EPT and to provide important metrics for randomized clinical trials. This chapter will review the NRN Follow-up Study Group's contributions to understanding factors related to improved neurodevelopmental, behavioral, and social-emotional outcomes of EPT infants. We will also discuss follow up challenges, including reassessing which outcomes are most meaningful for parents and investigators. Finally, we will explore how outcome studies have informed clinical decisions and ethical considerations, given limitations of prediction of complex later childhood outcomes from early neurodevelopmental findings.
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Affiliation(s)
- Howard W Kilbride
- Department of Pediatrics, Children's Mercy-Kansas City and the University of Missouri-Kansas City, 2401 Gillham Road, 3rd Floor Annex, Kansas City, MO.
| | - Betty R Vohr
- Department of Pediatrics, Women and Infants Hospital of Rhode Island and Brown University, Providence, RI
| | - Elisabeth M McGowan
- Department of Pediatrics, Women and Infants Hospital of Rhode Island and Brown University, Providence, RI
| | | | - Kimberlly Stringer
- Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL
| | - Abhik Das
- Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, MD
| | - Stephanie Wilson Archer
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Susan R Hintz
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
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12
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Wang Q, Jiang S, Hu X, Chen C, Cao Y, Lee SK, Liu JQ. The variation of antenatal corticosteroids administration for the singleton preterm birth in China, 2017 to 2018. BMC Pediatr 2022; 22:469. [PMID: 35922836 PMCID: PMC9347139 DOI: 10.1186/s12887-022-03529-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 07/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background The administration of antenatal corticosteroids (ACS) to women who are at risk of preterm birth has been proven to reduce not only the mortality, but also the major morbidities of the preterm infants. The rate of ACS and the risk factors associated with ACS use in Chinese population is unclear. This study aimed to investigate the rate of ACS use and the associated perinatal factors in the tertiary maternal centers of China. Methods Data for this retrospective observational study came from a clinical database of preterm infants established by REIN-EPIQ trial. All infants born at < 34 weeks of gestation and admitted to 18 tertiary maternal centers in China from 2017 to 2018 were enrolled. Any dose of dexamethasone was given prior to preterm delivery was recorded and the associated perinatal factors were analyzed. Results The rate of ACS exposure in this population was 71.2% (range 20.2 – 92%) and the ACS use in these 18 maternal centers varied from 20.2 to 92.0% in this period. ACS exposure was higher among women with preeclampsia, caesarean section delivery, antibiotic treatment and who delivered infants with lower gestational age and small for gestational age. ACS use was highest in the 28–31 weeks gestational age group, and lowest in the under 26 weeks of gestational age group (x2 = 65.478, P < 0.001). ACS exposure was associated with lower odds of bronchopulmonary dysplasia or death (OR, 0.778; 95% CI 0.661 to 0.916) and invasive respiration requirement (OR, 0.668; 95% CI 0.585 to 0.762) in this population. Conclusion The ACS exposure was variable among maternity hospitals and quality improvement of ACS administration is warranted.
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Affiliation(s)
- Qing Wang
- Department of Neonatology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, #2699, Gaoke western Road, Pudong District, Shanghai, 201204, China
| | - Siyuan Jiang
- Department of Neonatology, Children's Hospital of Fudan University, #399, Wanyuan Road, Minghang District, Shanghai, 201102, China
| | - Xuefeng Hu
- Department of Neonatology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, #2699, Gaoke western Road, Pudong District, Shanghai, 201204, China
| | - Chao Chen
- Department of Neonatology, Children's Hospital of Fudan University, #399, Wanyuan Road, Minghang District, Shanghai, 201102, China
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University, #399, Wanyuan Road, Minghang District, Shanghai, 201102, China.
| | - Shoo Kim Lee
- Maternal-Infant Care Research Centre and Department of Pediatrics Mount Sinai Hospital, Department of Pediatrics, and #Department of Obstetrics and Gynecology and Dalla Lana School of Public Health, University of Toronto, 600 University Avenue, Room 19-231M, Toronto, ON, M5G 1X5, Canada.
| | - Jiang-Qin Liu
- Department of Neonatology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, #2699, Gaoke western Road, Pudong District, Shanghai, 201204, China.
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13
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Ninan K, Liyanage SK, Murphy KE, Asztalos EV, McDonald SD. Evaluation of Long-term Outcomes Associated With Preterm Exposure to Antenatal Corticosteroids: A Systematic Review and Meta-analysis. JAMA Pediatr 2022; 176:e220483. [PMID: 35404395 PMCID: PMC9002717 DOI: 10.1001/jamapediatrics.2022.0483] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
IMPORTANCE Animal studies have found that antenatal corticosteroids affect many organs across multiple stages of life. However, the long-term outcomes in human children are not well understood. OBJECTIVE To conduct a systematic review and meta-analysis of long-term outcomes associated with preterm exposure to antenatal corticosteroids compared with no exposure in all children as well as children with preterm and full-term birth. DATA SOURCES Academic databases were searched for articles published from January 1, 2000, to October 29, 2021, including Ovid MEDLINE, Ovid Embase, PsycInfo, CINAHL (Cumulative Index of Nursing and Allied Health Literature), Web of Science, ClinicalTrials.gov, and Google Scholar. References of articles were also searched for relevant studies. STUDY SELECTION Randomized clinical trials (RCTs), quasi-RCTs, and cohort studies that assessed long-term neurodevelopmental, psychological, or other outcomes at 1 year or older in those who had preterm exposure to antenatal corticosteroids were included. No language restrictions were set. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data using a piloted data extraction form. Data on study population, pregnancy characteristics, exposure to antenatal corticosteroids, and outcomes were collected. Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines were followed, and random-effects models were used for the meta-analysis. MAIN OUTCOMES AND MEASURES The primary outcome was an author-defined composite of any adverse neurodevelopmental and/or psychological disorder. The secondary outcomes included specific measures of psychological disorders; neurodevelopmental delay; and anthropometric, metabolic, and cardiorespiratory outcomes. RESULTS A total of 30 studies met the inclusion criteria, and involved more than 1.25 million children who were at least 1 year of age when the outcomes were assessed. Exposure to a single course of antenatal corticosteroids for children with extremely preterm birth was associated with a significant reduction in risk of neurodevelopmental impairment (adjusted odds ratio, 0.69 [95% CI, 0.57-0.84]; I2 = 0%; low certainty). For children with late-preterm birth, exposure to antenatal corticosteroids was associated with a higher risk of investigation for neurocognitive disorders (n = 25 668 children; adjusted hazard ratio [aHR], 1.12 [95% CI, 1.05-1.20]; low certainty). For children with full-term birth, exposure to antenatal corticosteroids was associated with a higher risk of mental or behavioral disorders (n = 641 487 children; aHR, 1.47 [95% CI, 1.36-1.60]; low certainty) as well as proven or suspected neurocognitive disorders (n = 529 205 children; aHR, 1.16 [95% CI, 1.10-1.21]; low certainty). CONCLUSIONS AND RELEVANCE Results of this study showed that exposure to a single course of antenatal corticosteroids was associated with a significantly lower risk of neurodevelopmental impairment in children with extremely preterm birth but a significantly higher risk of adverse neurocognitive and/or psychological outcomes in children with late-preterm and full-term birth, who made up approximately half of those with exposure to antenatal corticosteroids. The findings suggest a need for caution in administering antenatal corticosteroids.
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Affiliation(s)
- Kiran Ninan
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sugee K. Liyanage
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Kellie E. Murphy
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth V. Asztalos
- Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Sarah D. McDonald
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada,Department of Radiology, McMaster University, Hamilton, Ontario, Canada,Division of Maternal-Fetal Medicine, McMaster University, Hamilton, Ontario, Canada
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14
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Soni R, Tscherning Wel-Wel C, Robertson NJ. Neuroscience meets nurture: challenges of prematurity and the critical role of family-centred and developmental care as a key part of the neuroprotection care bundle. Arch Dis Child Fetal Neonatal Ed 2022; 107:242-249. [PMID: 33972264 DOI: 10.1136/archdischild-2020-319450] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 04/01/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023]
Abstract
Advances in neonatal-perinatal medicine have resulted in increased survival at lower gestations. Although the incidence of germinal matrix haemorrhage-intraventricular haemorrhage and cystic periventricular leucomalacia is reducing, a new phenotype of preterm brain injury has emerged consisting of a combination of destructive and dysmaturational effects. Consequently, severe neurological disability is reported at a lower rate than previously, but the overall morbidity associated with premature birth continues to present a large global burden and contributes significantly to increased financial costs to health systems and families. In this review, we examine the developmental milestones of fetal brain development and how preterm birth can disrupt this trajectory. We review common morbidities associated with premature birth today. Although drug-based and cell-based neuroprotective therapies for the preterm brain are under intense study, we outline basic, sustainable and effective non-medical, family-centred and developmental care strategies which have the potential to improve neurodevelopmental outcomes for this population and need to be considered part of the future neuroprotection care bundle.
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Affiliation(s)
- Roopali Soni
- Neonatology, Sidra Medical and Research Center, Doha, Ad Dawhah, Qatar .,Department of Neonatology, Mediclinic Parkview Hospital, Dubai, UAE
| | - Charlotte Tscherning Wel-Wel
- Neonatology, Sidra Medical and Research Center, Doha, Ad Dawhah, Qatar.,Center of Physiopathology Toulouse-Purpan(CPTP), University of Toulouse, Toulouse, France
| | - Nicola J Robertson
- Institute for Women's Health, University College London, London, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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15
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Cha JH, Ahn JH, Kim YJ, Lee BG, Kim JI, Park HK, Kim BN, Lee HJ. Impact of Preterm Birth on Neurodevelopmental Disorders in South Korea: A Nationwide Population-Based Study. J Clin Med 2022; 11:2476. [PMID: 35566601 PMCID: PMC9099635 DOI: 10.3390/jcm11092476] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 12/14/2022] Open
Abstract
Neurodevelopmental disorder (NDD) in preterm infants has become of great interest. We aimed to investigate the impact of preterm birth on the proportion of NDD using nationwide data provided by the Korean National Health Insurance Service. We included 4894 extremely preterm or extremely low-birth-weight (EP/ELBW; <28 weeks of gestation or birth weight < 1000 g) infants, 70,583 other preterm or low-birth-weight (OP/LBW; 28−36 weeks of gestation or birth weight < 2500 g) infants, and 264,057 full-term infants born between 2008 and 2015. We observed their neurodevelopment until 6 years of age or until the year 2019, whichever occurred first. Diagnoses of NDDs were based on the World Health Organization’s International Classification of Diseases 10th revision. An association between preterm birth and NDD was assessed using a multivariable logistic regression model. There was a stepwise increase in the risk of overall NDD with increasing degree of prematurity, from OP/LBW (adjusted odds ratio 4.46; 95% confidence interval 4.34−4.58), to EP/ELBW (16.15; 15.21−17.15). The EP/ELBW group was strongly associated with developmental delay (21.47; 20.05−22.99), cerebral palsy (88.11; 79.89−97.19), and autism spectrum disorder (11.64; 10.37−13.06). Preterm birth considerably increased the risk of NDD by the degree of prematurity.
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Affiliation(s)
- Jong Ho Cha
- Department of Pediatrics, Hanyang University Hospital, Hanyang University College of Medicine, Seoul 04763, Korea; (J.H.C.); (J.-H.A.); (H.-K.P.)
| | - Ja-Hye Ahn
- Department of Pediatrics, Hanyang University Hospital, Hanyang University College of Medicine, Seoul 04763, Korea; (J.H.C.); (J.-H.A.); (H.-K.P.)
| | - Yun Jin Kim
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul 04763, Korea;
| | - Bong Gun Lee
- Department of Orthopedic Surgery, Hanyang University Hospital, Hanyang University College of Medicine, Seoul 04763, Korea;
| | - Johanna Inhyang Kim
- Clinical Research Institute of Developmental Medicine, Hanyang University Hospital, Seoul 04763, Korea;
- Department of Psychiatry, Hanyang University Hospital, Hanyang University College of Medicine, Seoul 04763, Korea
| | - Hyun-Kyung Park
- Department of Pediatrics, Hanyang University Hospital, Hanyang University College of Medicine, Seoul 04763, Korea; (J.H.C.); (J.-H.A.); (H.-K.P.)
- Clinical Research Institute of Developmental Medicine, Hanyang University Hospital, Seoul 04763, Korea;
| | - Bung-Nyun Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul 03080, Korea
| | - Hyun Ju Lee
- Department of Pediatrics, Hanyang University Hospital, Hanyang University College of Medicine, Seoul 04763, Korea; (J.H.C.); (J.-H.A.); (H.-K.P.)
- Clinical Research Institute of Developmental Medicine, Hanyang University Hospital, Seoul 04763, Korea;
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16
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Bell EF, Hintz SR, Hansen NI, Bann CM, Wyckoff MH, DeMauro SB, Walsh MC, Vohr BR, Stoll BJ, Carlo WA, Van Meurs KP, Rysavy MA, Patel RM, Merhar SL, Sánchez PJ, Laptook AR, Hibbs AM, Cotten CM, D’Angio CT, Winter S, Fuller J, Das A. Mortality, In-Hospital Morbidity, Care Practices, and 2-Year Outcomes for Extremely Preterm Infants in the US, 2013-2018. JAMA 2022; 327:248-263. [PMID: 35040888 PMCID: PMC8767441 DOI: 10.1001/jama.2021.23580] [Citation(s) in RCA: 240] [Impact Index Per Article: 120.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/10/2021] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Despite improvement during recent decades, extremely preterm infants continue to contribute disproportionately to neonatal mortality and childhood morbidity. OBJECTIVE To review survival, in-hospital morbidities, care practices, and neurodevelopmental and functional outcomes at 22-26 months' corrected age for extremely preterm infants. DESIGN, SETTING, AND PARTICIPANTS Prospective registry for extremely preterm infants born at 19 US academic centers that are part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. The study included 10 877 infants born at 22-28 weeks' gestational age between January 1, 2013, and December 31, 2018, including 2566 infants born before 27 weeks between January 1, 2013, and December 31, 2016, who completed follow-up assessments at 22-26 months' corrected age. The last assessment was completed on August 13, 2019. Outcomes were compared with a similar cohort of infants born in 2008-2012 adjusting for gestational age. EXPOSURES Extremely preterm birth. MAIN OUTCOMES AND MEASURES Survival and 12 in-hospital morbidities were assessed, including necrotizing enterocolitis, infection, intracranial hemorrhage, retinopathy of prematurity, and bronchopulmonary dysplasia. Infants were assessed at 22-26 months' corrected age for 12 health and functional outcomes, including neurodevelopment, cerebral palsy, vision, hearing, rehospitalizations, and need for assistive devices. RESULTS The 10 877 infants were 49.0% female and 51.0% male; 78.3% (8495/10848) survived to discharge, an increase from 76.0% in 2008-2012 (adjusted difference, 2.0%; 95% CI, 1.0%-2.9%). Survival to discharge was 10.9% (60/549) for live-born infants at 22 weeks and 94.0% (2267/2412) at 28 weeks. Survival among actively treated infants was 30.0% (60/200) at 22 weeks and 55.8% (535/958) at 23 weeks. All in-hospital morbidities were more likely among infants born at earlier gestational ages. Overall, 8.9% (890/9956) of infants had necrotizing enterocolitis, 2.4% (238/9957) had early-onset infection, 19.9% (1911/9610) had late-onset infection, 14.3% (1386/9705) had severe intracranial hemorrhage, 12.8% (1099/8585) had severe retinopathy of prematurity, and 8.0% (666/8305) had severe bronchopulmonary dysplasia. Among 2930 surviving infants with gestational ages of 22-26 weeks eligible for follow-up, 2566 (87.6%) were examined. By 2-year follow-up, 8.4% (214/2555) of children had moderate to severe cerebral palsy, 1.5% (38/2555) had bilateral blindness, 2.5% (64/2527) required hearing aids or cochlear implants, 49.9% (1277/2561) had been rehospitalized, and 15.4% (393/2560) required mobility aids or other supportive devices. Among 2458 fully evaluated infants, 48.7% (1198/2458) had no or mild neurodevelopmental impairment at follow-up, 29.3% (709/2419) had moderate neurodevelopmental impairment, and 21.2% (512/2419) had severe neurodevelopmental impairment. CONCLUSIONS AND RELEVANCE Among extremely preterm infants born in 2013-2018 and treated at 19 US academic medical centers, 78.3% survived to discharge, a significantly higher rate than for infants born in 2008-2012. Among infants born at less than 27 weeks' gestational age, rehospitalization and neurodevelopmental impairment were common at 2 years of age.
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Affiliation(s)
| | - Susan R. Hintz
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Nellie I. Hansen
- Social, Statistical, and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina
| | - Carla M. Bann
- Social, Statistical, and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina
| | - Myra H. Wyckoff
- Department of Pediatrics, University of Texas Southwestern, Dallas
| | - Sara B. DeMauro
- Department of Pediatrics, University of Pennsylvania, Philadelphia
| | - Michele C. Walsh
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Betty R. Vohr
- Department of Pediatrics, Brown University, Providence, Rhode Island
| | - Barbara J. Stoll
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | | | | | | | - Ravi M. Patel
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | | | - Pablo J. Sánchez
- Department of Pediatrics, The Ohio State University and Nationwide Children’s Hospital, Columbus
| | - Abbot R. Laptook
- Department of Pediatrics, Brown University, Providence, Rhode Island
| | - Anna Maria Hibbs
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
| | | | - Carl T. D’Angio
- Department of Pediatrics, University of Rochester, Rochester, New York
| | - Sarah Winter
- Department of Pediatrics, University of Utah, Salt Lake City
| | - Janell Fuller
- Department of Pediatrics, University of New Mexico, Albuquerque
| | - Abhik Das
- Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, Maryland
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17
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Huang HB, Watt MJ, Hicks M, Zhang QS, Lin F, Wan XQ, Chow CB, Cheung PY. A Family-Centered, Multidisciplinary Clinic for Early Diagnosis of Neurodevelopmental Impairment and Cerebral Palsy in China-A Pilot Observation. Front Pediatr 2022; 10:840190. [PMID: 35372170 PMCID: PMC8968569 DOI: 10.3389/fped.2022.840190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/20/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Comprehensive multidisciplinary assessment of neurodevelopmental outcomes of high-risk neonates may have significant challenges in low- and middle-income countries, in addition to socio-cultural barriers. We aimed to compare the time to diagnosis of neurodevelopmental impairment (NDI) and cerebral palsy (CP) in preterm neonates (<29 weeks) at a multidisciplinary assessment and care (MDAC) clinic with that of a conventional high-risk infant follow-up clinic in China. METHODS All eligible surviving very preterm neonates born at <29 weeks gestation at the University of Hong Kong-Shenzhen Hospital between January 2015 and December 2019 were followed up in conventional (2015-2017) and MDAC (2018-2020) clinics up to 2 years corrected age with clinical demographic information collected in a prospective database. The MDAC team used standardized developmental assessments. The rates and timing of diagnosing NDI and CP in two epochs were compared. RESULTS The rates of NDI and CP were not different in two epochs [NDI: 12 (50%) vs. 12 (41%); CP: 3 (12%) vs. 2 (7%) of 24 and 29 surviving infants assessed in conventional and MDAC clinics, respectively]. Infants in the MDAC clinic were diagnosed with NDI and CP earlier than those in the pre-MDAC epoch (6 vs. 14 months corrected age, respectively, P < 0.05). CONCLUSION High-risk preterm neonates can be followed more effectively in a family-centered, child-friendly multidisciplinary clinic, leading to an earlier diagnosis of NDI and CP. Early counseling and interventions could be implemented accordingly.
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Affiliation(s)
- Hai-Bo Huang
- Department of Pediatrics, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Man Joe Watt
- Department of Pediatrics, University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Pediatrics, Glenrose Rehabilitation Hospital, University of Alberta, Edmonton, AB, Canada.,Department of Physical Medicine and Rehabilitation, Glenrose Rehabilitation Hospital, University of Alberta, Edmonton, AB, Canada
| | - Matthew Hicks
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Qian-Shen Zhang
- Department of Pediatrics, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Fang Lin
- Department of Pediatrics, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xue-Qing Wan
- Department of Pediatrics, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Chun-Bong Chow
- Department of Pediatrics, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Po-Yin Cheung
- Department of Pediatrics, University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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18
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Lavilla OC, Aziz KB, Lure AC, Gipson D, de la Cruz D, Wynn JL. Hourly Kinetics of Critical Organ Dysfunction in Extremely Preterm Infants. Am J Respir Crit Care Med 2022; 205:75-87. [PMID: 34550843 PMCID: PMC8865589 DOI: 10.1164/rccm.202106-1359oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Rationale: Use of severity of illness scores to classify patients for clinical care and research is common outside of the neonatal ICU. Extremely premature (<29 weeks' gestation) infants with extremely low birth weight (<1,000 g) experience significant mortality and develop severe pathology during the protracted birth hospitalization. Objectives: To measure at high resolution the changes in organ dysfunction that occur from birth to death or discharge home by gestational age and time, and among extremely preterm infants with and without clinically meaningful outcomes using the neonatal sequential organ failure assessment score. Methods: A single-center, retrospective, observational cohort study of inborn, extremely preterm infants with extremely low birth weight admitted between January 2012 and January 2020. Neonatal sequential organ failure assessment scores were calculated every hour for every patient from admission until death or discharge. Measurements and Main Results: Longitudinal, granular scores from 436 infants demonstrated early and sustained discrimination of those who died versus those who survived to discharge. The discrimination for mortality by the maximum score was excellent (area under curve, 0.91; 95% confidence intervals, 0.88-0.94). Among survivors with and without adverse outcomes, most score variation occurred at the patient level. The weekly average score over the first 28 days was associated with the sum of adverse outcomes at discharge. Conclusions: The neonatal sequential organ failure assessment score discriminates between survival and nonsurvival on the first day of life. The major contributor to score variation occurred at the patient level. There was a direct association between scores and major adverse outcomes, including death.
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Affiliation(s)
| | - Khyzer B. Aziz
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland
| | | | | | | | - James L. Wynn
- Department of Pediatrics and,Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida; and
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19
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Carmo ALSD, Fredo FW, Bruck I, Lima JDRMD, Janke RNRGH, Fogaça TDGM, Glaser JA, Riechi TIJDS, Antoniuk SA. Neurological, cognitive and learning evaluation of students who were born preterm. REVISTA PAULISTA DE PEDIATRIA 2021; 40:e2020252. [PMID: 34346991 PMCID: PMC8331067 DOI: 10.1590/1984-0462/2022/40/2020252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 11/22/2020] [Indexed: 11/21/2022]
Abstract
Objective: To evaluate the cognitive and academic profile of preterm newborns at school age and to determine the factors related to prematurity and sociodemographic profile that influence these results. Methods: Patients aged 6-14 years old that were assisted in the preterm follow-up clinic were recruited. The cognitive, academic, and neurological capacities were accessed through a detailed evaluation with a child neurologist, a neuropsychologist and a psychopedagogue. Neonatal data were collected from patient records. Results: 97 children were included and 14 were excluded from the study, resulting in 83 children. Gestational age (GA) was 30±3 weeks and weight at birth was 1138g (605 to 4185g). Poor performance was shown in 38.4% for writing, 57.5% for reading and 42.5% for mathematics. The mean total intelligence quotient (IQ) was 96±14.9 points, and 10.9% were considered altered. Children with unstructured families presented 78.3% of failure in reading tests (p=0.029). The multivariate analysis showed association between GA at birth and classic mini-mental score (p=0.043), total IQ (p=0.047), perceptual organization IQ (p=0.035), and processing speed IQ (p=0.036). There was also association between weight at birth and the classic (p=0.004) and adapted (p=0.007) mini-mental scores; invasive mechanic ventilation duration and classic mini-mental (p=0.049); and lower maternal age and processing speed IQ (p=0.033). Conclusions: Preterm infants at school age had high frequency of failure in cognitive and academic evaluation tests. Learning difficulties are high among them. Multiple neonatal variables are related with altered cognitive and students development.
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Affiliation(s)
| | | | - Isac Bruck
- Universidade Federal do Paraná. Curitiba, PR, Brasil
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20
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Setänen S, Fredriksson Kaul Y, Johansson M, Montgomery C, Naseh N, Holmström G, Strand‐Brodd K, Hellström‐Westas L. Using different definitions affected the reported prevalence of neurodevelopmental impairment in children born very preterm. Acta Paediatr 2021; 110:838-845. [PMID: 32640081 DOI: 10.1111/apa.15464] [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: 05/18/2020] [Revised: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 12/14/2022]
Abstract
AIM We investigated the impact of varying definitions on the prevalence of neurodevelopmental impairment (NDI) in children born very preterm at 6.5 years of age. METHODS Cognitive development and neurosensory impairments were assessed in 91 children (40/51 girls/boys) born <32 gestational weeks, in 2004-2007 in Uppsala county, Sweden. The results were compared with data from a reference group of 67 children born full term. The prevalence of NDI in the present cohort was reported according to definitions used by seven contemporary studies of children born very or extremely preterm. RESULTS The prevalence of severe NDI varied from 2% to 23% depending on the definition used. The prevalence of cognitive impairment varied from 2% (-3 SD according to test norms) to 16% (-2 SD according to control group), the prevalence of cerebral palsy from 0% (severe) to 9% (any) and the prevalence of severe visual impairment from 0% (blindness) to 1% (visual acuity < 0.3). There were no children with severe hearing impairment. CONCLUSION A high variability in definitions affects the reporting of the prevalence of NDI in long-term follow-up studies of very or extremely preterm born children. There is a need for a better consensus to enable comparisons across studies.
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Affiliation(s)
- Sirkku Setänen
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | | | - Martin Johansson
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Cecilia Montgomery
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Nima Naseh
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Gerd Holmström
- Department of Neuroscience, Ophtalmology Uppsala University Uppsala Sweden
| | - Katarina Strand‐Brodd
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
- Centre for Clinical Research Sörmland Uppsala University Uppsala Sweden
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21
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Abstract
Continuous quality improvement (CQI) has become a vital component of newborn medicine. Applying core principles - robust measurement, repeated small tests of change, collaborative learning through data sharing - have led to improvements in care quality, safety, and outcomes in the Neonatal Intensive Care Unit (NICU). High-risk infant follow-up programs (HRIF) have historically aided such quality improvement efforts by providing outcomes data about NICU interventions. Though as a discipline, HRIF has not universally embraced CQI for its own practice. In this review, we summarize the history of CQI in neonatology and applications of improvement science in healthcare and describe examples of CQI in HRIF. We identify the need for consensus on what defines 'high-risk' and constitutes meaningful outcomes. Last, we outline four areas for future investment: establishing evidence-based care delivery systems, standardizing outcomes and their measures, embracing a family-centered approach prioritizing parent goals, and developing professional standards of care for HRIF.
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Affiliation(s)
- Jonathan S Litt
- Department of Neonatology, Beth Israel Deaconess Medical Center Boston, 330 Brookline Avenue, Rose 3, 02215, Boston, MA, USA; Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Susan R Hintz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford School of Medicine, 750 Welch Road, Suite 315, Palo Alto, 94034, Stanford, CA, USA; California Perinatal Quality Care Collaborative-California Children's Services High Risk Infant Follow-Up Quality of Care Initiative, San Francisco, CA, USA.
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22
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Rysavy MA, Colaizy TT, Bann CM, DeMauro SB, Duncan AF, Brumbaugh JE, Peralta-Carcelen M, Harmon HM, Johnson KJ, Hintz SR, Vohr BR, Bell EF. The relationship of neurodevelopmental impairment to concurrent early childhood outcomes of extremely preterm infants. J Perinatol 2021; 41:2270-2278. [PMID: 33758389 PMCID: PMC7985590 DOI: 10.1038/s41372-021-00999-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/19/2021] [Accepted: 02/04/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Determine how neurodevelopmental impairment (NDI) relates to concurrent outcomes for children born extremely preterm. STUDY DESIGN Retrospective cohort study children born 22 0/7-26 6/7 weeks' gestation at NICHD Neonatal Research Network hospitals. Outcomes were ascertained at 18-22 months' corrected age. RESULT Of 6562 children, 2618 (40%) died and 441 (7%) had no follow-up. Among the remaining 3483 children, 825 (24%), 1576 (45%), 657 (19%), and 425 (12%) had no, potential/mild, moderate, and severe NDI, respectively. Rehospitalization, respiratory medications, surgery, and medical support services were associated with greater NDI severity but affected >10% of children without NDI. Rehospitalization occurred in 40% of children with no NDI (mean (SD): 1.7 (1.3) episodes). CONCLUSION Medical, functional, and social outcomes at 18-22 months' corrected age were associated with NDI; however, many children without NDI were affected. These data should contribute to counseling families and the design of studies for childhood outcomes beyond NDI.
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Affiliation(s)
- Matthew A. Rysavy
- grid.214572.70000 0004 1936 8294Stead Family Department of Pediatrics, University of Iowa, Iowa, IA USA
| | - Tarah T. Colaizy
- grid.214572.70000 0004 1936 8294Stead Family Department of Pediatrics, University of Iowa, Iowa, IA USA
| | - Carla M. Bann
- grid.62562.350000000100301493Statistics and Epidemiology Unit, RTI International, Research Triangle Park, NC USA
| | - Sara B. DeMauro
- grid.25879.310000 0004 1936 8972Department of Pediatrics, University of Pennsylvania, Philadelphia, PA USA
| | - Andrea F. Duncan
- grid.25879.310000 0004 1936 8972Department of Pediatrics, University of Pennsylvania, Philadelphia, PA USA
| | - Jane E. Brumbaugh
- grid.66875.3a0000 0004 0459 167XDepartment of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN USA
| | - Myriam Peralta-Carcelen
- grid.265892.20000000106344187Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL USA
| | - Heidi M. Harmon
- grid.214572.70000 0004 1936 8294Stead Family Department of Pediatrics, University of Iowa, Iowa, IA USA
| | - Karen J. Johnson
- grid.214572.70000 0004 1936 8294Stead Family Department of Pediatrics, University of Iowa, Iowa, IA USA
| | - Susan R. Hintz
- grid.168010.e0000000419368956Department of Pediatrics, Stanford University, Palo Alto, CA USA
| | - Betty R. Vohr
- grid.40263.330000 0004 1936 9094Department of Pediatrics, Brown University, Providence, RI USA
| | - Edward F. Bell
- grid.214572.70000 0004 1936 8294Stead Family Department of Pediatrics, University of Iowa, Iowa, IA USA
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23
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Flynn RS, Huber MD, DeMauro SB. Predictive Value of the BSID-II and the Bayley-III for Early School Age Cognitive Function in Very Preterm Infants. Glob Pediatr Health 2020; 7:2333794X20973146. [PMID: 33283025 PMCID: PMC7683841 DOI: 10.1177/2333794x20973146] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/16/2020] [Accepted: 10/12/2020] [Indexed: 11/15/2022] Open
Abstract
Objective To compare the predictive validity of the Bayley Scales of Infant Development, Second Edition (BSID-II) and the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) for cognitive function at early school age in very preterm infants. Methods Seventy-seven former preterm infants (born <32 weeks gestation and ≤2000 g) completed both the BSID-II and the Bayley-III at 2 years corrected age. Children enrolled at hospitals that perform follow-up beyond 2 years had cognitive assessments with the Wechsler Preschool and Primary Scale of Intelligence Fourth Edition (WPPSI-IV). Associations between Bayley and WPPSI scores were assessed using correlation coefficients, linear regression, and Bland-Altman plots. Results Thirty-one of 45 eligible children were tested with the WPPSI-IV at 47 ± 11 months. Average BSID-II Mental Development Index (MDI) was 86 ± 19, Bayley-III Cognitive composite score was 101 ± 12 and WPPSI Full Scale IQ (FSIQ) was 96 ± 12. Correlation between MDI and FSIQ was 0.54 (P < .001); correlation between Bayley-III cognitive composite score and FSIQ was 0.31 (P = .03). Bayley-III language composite had a modestly stronger correlation with FSIQ than cognitive composite (correlation coefficient 0.39; P = .005). Linear regression models also demonstrated that BSID-II was more closely correlated with FSIQ than Bayley-III. This bias was consistent across the full range of scores. Conclusion The BSID-II underestimated FSIQ and the Bayley-III overestimated FSIQ. Children at risk for impairment might be missed with the Bayley-III. As the Bayley-4 is introduced, clinicians and researchers should be cautious about interpretation of scores until performance of this new measure is fully understood.
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Affiliation(s)
- Rachel S Flynn
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Sara B DeMauro
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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24
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Williams N, Synnes A, O'Brien C, Albersheim S. An alternative approach to developing guidelines for the management of an anticipated extremely preterm infant. J Perinat Med 2020; 48:751-756. [PMID: 32726290 DOI: 10.1515/jpm-2019-0444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 07/02/2020] [Indexed: 11/15/2022]
Abstract
Objectives To identify the probability of survival and severe neurodevelopmental impairment (sNDI) at which perinatal physicians would or would not offer or recommend resuscitation at birth for extremely preterm infants. Methods A Delphi process consisting of five rounds was implemented to seek consensus (>80% agreement) amongst British Columbia perinatal physicians. The first-round consisted of neonatal and maternal-fetal-medicine Focus Groups. Rounds two to five surveyed perinatal physicians, building upon previous rounds. Draft guidelines were developed and agreement sought. Results Based on 401 responses across all rounds, consensus was obtained that resuscitation should not be offered if survival probability <5%, not recommended if survival probability 5 to <10%, resuscitation recommended if survival without sNDI probability >70 to 90% and resuscitation standard care if survival without sNDI >90%. Conclusions This physician consensus-based, objective framework for the management of an anticipated extremely preterm infant is a transparent alternative to existing guidelines, minimizing gestational-ageism and allowing for individualized management utilizing up-to-date data. Further input from other key stakeholders will be required prior to guideline implementation.
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Affiliation(s)
- Nicholas Williams
- Department of Paediatrics, University of British Columbia, Vancouver, BC, Canada
- Division of Neonatology, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Anne Synnes
- Department of Paediatrics, University of British Columbia, Vancouver, BC, Canada
- Division of Neonatology, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Claire O'Brien
- Department of Paediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Susan Albersheim
- Department of Paediatrics, University of British Columbia, Vancouver, BC, Canada
- Division of Neonatology, British Columbia Women's Hospital, Vancouver, BC, Canada
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25
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Draper ES, Zeitlin J, Manktelow BN, Piedvache A, Cuttini M, Edstedt Bonamy AK, Maier R, Koopman-Esseboom C, Gadzinowski J, Boerch K, van Reempts P, Varendi H, Johnson SJ. EPICE cohort: two-year neurodevelopmental outcomes after very preterm birth. Arch Dis Child Fetal Neonatal Ed 2020; 105:350-356. [PMID: 31690558 PMCID: PMC7363786 DOI: 10.1136/archdischild-2019-317418] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 10/08/2019] [Accepted: 10/22/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine whether the variation in neurodevelopmental disability rates between populations persists after adjustment for demographic, maternal and infant characteristics for an international very preterm (VPT) birth cohort using a standardised approach to neurodevelopmental assessment at 2 years of age. DESIGN Prospective standardised cohort study. SETTING 15 regions in 10 European countries. PATIENTS VPT births: 22+0-31+6 weeks of gestation. DATA COLLECTION Standardised data collection tools relating to pregnancy, birth and neonatal care and developmental outcomes at 2 years corrected age using a validated parent completed questionnaire. MAIN OUTCOME MEASURES Crude and standardised prevalence ratios calculated to compare rates of moderate to severe neurodevelopmental impairment between regions grouped by country using fixed effects models. RESULTS Parent reported rates of moderate or severe neurodevelopmental impairment for the cohort were: 17.3% (ranging 10.2%-26.1% between regions grouped by country) with crude standardised prevalence ratios ranging from 0.60 to 1.53. Adjustment for population, maternal and infant factors resulted in a small reduction in the overall variation (ranging from 0.65 to 1.30). CONCLUSION There is wide variation in the rates of moderate to severe neurodevelopmental impairment for VPT cohorts across Europe, much of which persists following adjustment for known population, maternal and infant factors. Further work is needed to investigate whether other factors including quality of care and evidence-based practice have an effect on neurodevelopmental outcomes for these children.
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Affiliation(s)
- Elizabeth S Draper
- Department of Health Sciences, University of Leicester, Leicester, Leicestershire, UK
| | - Jennifer Zeitlin
- Obstetrical, Perinatal and Paediatric Epidemiology Research Group, Centre for Epidemiology and Biostatistics (U1153), INSERM, Paris, France
| | - Bradley N Manktelow
- Department of Health Sciences, University of Leicester, Leicester, Leicestershire, UK
| | - Aurelie Piedvache
- Obstetrical, Perinatal and Paediatric Epidemiology Research Group, Centre for Epidemiology and Biostatistics (U1153), INSERM, Paris, France
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesu Pediatric Hospital, Roma, Lazio, Italy
| | - Anna-Karin Edstedt Bonamy
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Rolf Maier
- Children's Hospital, University Hospital, Philipps-Universitat Marburg, Marburg, Germany
| | - Corine Koopman-Esseboom
- Department of Neonatology, University Medical Centre Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Janusz Gadzinowski
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Klaus Boerch
- Department of Paediatrics, Hvidovre Hospital, Hvidovre, Denmark
| | - Patrick van Reempts
- Department of Neonatology, University of Antwerp and Antwerp University Hospital, Edegem, Belgium
| | - Heili Varendi
- Tartu University Hospital, University of Tartu, Tartu, Estonia
| | - Samantha J Johnson
- Department of Health Sciences, University of Leicester, Leicester, Leicestershire, UK
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26
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Torchin H, Morgan AS, Ancel PY. International comparisons of neurodevelopmental outcomes in infants born very preterm. Semin Fetal Neonatal Med 2020; 25:101109. [PMID: 32354556 DOI: 10.1016/j.siny.2020.101109] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We summarise rates of survival and neurodevelopmental impairment in very (<32 weeks' gestation) and extremely (<28 weeks' gestation) preterm infants using data from recent meta-analyses. Methodological issues that require consideration when comparing international data are highlighted using examples of population-based or multi-centre cohorts of children born extremely preterm. The impact of baseline population, outcome definition, gestational age assessment, age at neurodevelopmental assessment, year of birth and follow-up rates are discussed. The impact of the intensity of perinatal care and of post-discharge management on survival and neurodevelopmental outcomes is also discussed. There is a future need for harmonisation of data collection and for more accurate and standardised reporting of neurodevelopmental outcomes in very preterm children.
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Affiliation(s)
- Héloïse Torchin
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France; Department of Neonatal Medicine, Cochin-Port Royal Hospital, AP-HP, Paris, F-75014, France.
| | - Andreï S Morgan
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France; Elizabeth Garrett Anderson Institute for Womens' Health, UCL, 74 Huntley Street, London, WC1E 6AU, UK; SAMU 93 - SMUR Pédiatrique, CHI André Grégoire, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, Assistance Publique des Hôpitaux de Paris, Montreuil, France.
| | - Pierre-Yves Ancel
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France; Clinical Research Unit, Centre for Clinical Investigation P1419, APHP.CUP, F-75014, Paris, France.
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27
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Janvier A, Bourque CJ, Dahan S, Robson K, Barrington KJ. Integrating Parents in Neonatal and Pediatric Research. Neonatology 2019; 115:283-291. [PMID: 30799397 DOI: 10.1159/000492502] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/26/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Parents and their infants are the beneficiaries of neonatal and pediatric research, but in the past they have been excluded from most stages of research projects. As a result, many projects may fail to produce the most worthwhile information for parents and families. Lately, veteran resource parents and patients have been increasingly integrated in research initiatives. METHODS Benchmarking of neonatal and pediatric research initiatives where resource parents and/or ex neonatal patients have helped to optimize pediatric research. We review ways in which resource parents/patients can be involved in research, with examples and practical ideas of how to proceed. RESULTS Resource parents/patients can be collaborators in research and be integrated in many steps: prioritizing research projects, designing trials, determining the outcomes of interest, ethics review, developing and improving consent procedures, collection and interpretation of data, participation in data safety monitoring committees, publication of results, and presentation to peer groups. Some of the strategies for integration of stakeholders in clinical research are more complex, may involve risk and require more training than others. CONCLUSION We suggest that groups wanting to involve parents in their research endeavors start with simpler tasks that entail less risk and develop teams of resource parents who have differing interests and abilities. Quality control of programs is essential, such as frequently giving and obtaining feedback from resource parents/patients and researchers. In the future, integration of resource parents/patients into every step of clinical research will be essential to ensure that parent and family important outcomes are examined.
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Affiliation(s)
- Annie Janvier
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada, .,Division of Neonatology, Hôpital Sainte-Justine, Montréal, Québec, Canada, .,CHU Sainte-Justine Research Center, Montréal, Québec, Canada, .,Bureau de l'Éthique Clinique, Université de Montréal, Montréal, Québec, Canada, .,Unité d'Éthique Clinique, Hôpital Sainte-Justine, Montréal, Québec, Canada, .,Unité de Soins Palliatifs, Hôpital Sainte-Justine, Montréal, Québec, Canada, .,Unité de Recherche en Éthique Clinique et Partenariat Famille (UREPAF), Montréal, Québec, Canada,
| | - Claude Julie Bourque
- CHU Sainte-Justine Research Center, Montréal, Québec, Canada.,Unité d'Éthique Clinique, Hôpital Sainte-Justine, Montréal, Québec, Canada.,Unité de Recherche en Éthique Clinique et Partenariat Famille (UREPAF), Montréal, Québec, Canada
| | - Sonia Dahan
- Division of Neonatology, Hôpital Sainte-Justine, Montréal, Québec, Canada.,Unité d'Éthique Clinique, Hôpital Sainte-Justine, Montréal, Québec, Canada
| | - Kate Robson
- Sunnybrook Hospital, Toronto, Ontario, Canada
| | - Keith James Barrington
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada.,Division of Neonatology, Hôpital Sainte-Justine, Montréal, Québec, Canada.,CHU Sainte-Justine Research Center, Montréal, Québec, Canada
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28
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Synnes A, Hicks M. Neurodevelopmental Outcomes of Preterm Children at School Age and Beyond. Clin Perinatol 2018; 45:393-408. [PMID: 30144845 DOI: 10.1016/j.clp.2018.05.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Despite improved survival of preterm infants, there has not been an equivalent improvement in long-term neurodevelopmental outcomes. Adverse neurodevelopmental outcome rates and severity are inversely related to the degree of prematurity, but only 1.6% are born very preterm and the motor, cognitive, behavioral, and psychiatric disabilities in the large moderate and late preterm population have a greater impact. The disability-free preterm adult has a lower educational achievement and income but similar health-related quality of life to term controls. Reducing the long-term neurodevelopmental impact of prematurity is the next frontier of neonatal care.
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Affiliation(s)
- Anne Synnes
- Neonatal Follow-Up Program, British Columbia's Women's Hospital, University of British Columbia, Room 1R16, 4500 Oak Street, Vancouver, British Columbia V6H 3N1, Canada.
| | - Matthew Hicks
- Department of Pediatrics, Neonatal Intensive Care Unit, University of Alberta, 5027 Diagnosis and Treatment Centre, Royal Alexander Hospital, 10240 Kingsway Northwest, Edmonton, Alberta T5H 3V9, Canada
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29
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DeMauro SB, Schmidt B. Comparing Like with Like When Reporting Neurodevelopmental Outcomes after Preterm Birth. J Pediatr 2018; 197:10-12. [PMID: 29551315 DOI: 10.1016/j.jpeds.2018.01.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/12/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Sara B DeMauro
- The Children's Hospital of Philadelphia The University of Pennsylvania Perelman School of Medicine
| | - Barbara Schmidt
- The Children's Hospital of Philadelphia The University of Pennsylvania Perelman School of Medicine Philadelphia, Pennsylvania; Department of Clinical Epidemiology and Biostatistics McMaster University Hamilton, Ontario, Canada.
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