1
|
Li S, Feng Q, Huang X, Tian X, Zhou Y, Ji Y, Zhai S, Guo W, Zheng R, Wang H. Association of different doses of antenatal corticosteroids exposure with early major outcomes and early weight loss percentage in extremely preterm infants or extremely low birthweight infants: a multicentre cohort study. BMJ Paediatr Open 2024; 8:e002506. [PMID: 38897621 PMCID: PMC11191796 DOI: 10.1136/bmjpo-2024-002506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVES To determine the dose-dependent associations between antenatal corticosteroids (ANS) exposure and the rates of major morbidities, and the early weight loss percentage (EWLP) in hospital among extremely preterm infants (EPI) or extremely low birthweight infants (ELBWI). METHODS A multicentre, retrospective cohort study of EPI or ELBWI born between 2017 and 2018 was conducted. Infants were classified into no ANS, partial ANS and complete ANS exposure group; three subgroups were generated by gestational age and birth weight. Multiple logistic regression and multiple linear regression were performed. RESULTS There were 725 infants included from 32 centres. Among no ANS, partial ANS and complete ANS exposure, there were significant differences in the proportions of bronchopulmonary dysplasia (BPD) (24.5%, 25.4% and 16.1%), necrotising enterocolitis (NEC) (6.7%, 2.0% and 2.0%) and death (29.6%, 18.5% and 13.5%), and insignificant differences in the proportions of intraventricular haemorrhage (IVH) (12.5%, 13.2% and 12.2%), and extrauterine growth restriction (EUGR) (50.0%, 56.6% and 59.5%). In the logistic regression, compared with no ANS exposure, complete ANS reduced the risk of BPD (OR 0.58, 95% CI 0.37 to 0.91), NEC (OR 0.21, 95% CI 0.08 to 0.57) and death (OR 0.36, 95% CI 0.23 to 0.56), and partial ANS reduced the risk of NEC (OR 0.23, 95% CI 0.07 to 0.72) and death (OR 0.54, 95% CI 0.34 to 0.87). Compared with partial ANS exposure, complete ANS decreased the risk of BPD (OR 0.58, 95% CI 0.37 to 0.91). There were insignificant associations between ANS exposure and IVH, EUGR. In the multiple linear regression, partial and complete ANS exposure increased EWLP only in the ≥28 weeks (w) and <1000 g subgroup (p<0.05). CONCLUSIONS Different doses of ANS (dexamethasone) exposure were protectively associated with BPD, NEC, death in hospital, but not EUGR at discharge among EPI or ELBWI. Beneficial dose-dependent associations between ANS (dexamethasone) exposure and BPD existed. ANS exposure increased EWLP only in the ≥28 w and<1000 g subgroup. ANS administration, especially complete ANS, is encouraged before preterm birth. TRIAL REGISTRATION NUMBER NCT06082414.
Collapse
MESH Headings
- Humans
- Infant, Newborn
- Female
- Infant, Extremely Low Birth Weight
- Retrospective Studies
- Infant, Extremely Premature
- Male
- Pregnancy
- Weight Loss/drug effects
- Enterocolitis, Necrotizing/epidemiology
- Enterocolitis, Necrotizing/prevention & control
- Bronchopulmonary Dysplasia/epidemiology
- Bronchopulmonary Dysplasia/prevention & control
- Bronchopulmonary Dysplasia/mortality
- Dose-Response Relationship, Drug
- Adrenal Cortex Hormones/administration & dosage
- Adrenal Cortex Hormones/adverse effects
- Gestational Age
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/prevention & control
- Infant, Premature, Diseases/mortality
Collapse
Affiliation(s)
- Shuaijun Li
- Department of Maternal and Child Health, School of Public Health, Peking University Health Science Center-Weifang Joint Research Center for Maternal and Child Health, Peking University, Beijing, China
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Qi Feng
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xiaofang Huang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xiuying Tian
- Department of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China
| | - Ying Zhou
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Yong Ji
- Neonatal Intensive Care Unit, Children's Hospital of Shanxi, Taiyuan, China
| | - Shufen Zhai
- Department of Neonatology, Handan Central Hospital, Handan, China
| | - Wei Guo
- Department of Neonatology, Xingtai People's Hospital, Xingtai, China
| | - Rongxiu Zheng
- Department of Pediatrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Haijun Wang
- Department of Maternal and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center-Weifang Joint Research Center for Maternal and Child Health, Peking University School of Public Health, Beijing, China
| |
Collapse
|
2
|
Ghanem M, Zozaya C, Ibrahim J, Lee S, Mohsen N, Nasef N, Mohamed A. Correlation between early postnatal body weight changes and lung ultrasound scores as predictors of bronchopulmonary dysplasia in preterm infants: A secondary analysis of a prospective study. Eur J Pediatr 2024; 183:2123-2130. [PMID: 38363393 DOI: 10.1007/s00431-024-05464-z] [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: 12/31/2023] [Revised: 01/20/2024] [Accepted: 01/31/2024] [Indexed: 02/17/2024]
Abstract
Recent research links early weight changes (EWC) with bronchopulmonary dysplasia (BPD) in preterm neonates, while lung ultrasound score (LUS) has shown promise in predicting BPD. We aimed to explore the correlation between LUS and EWC as markers of extravascular lung edema and to investigate the correlation between LUS and EWC in preterm infants with respiratory distress syndrome regarding future BPD development. This secondary analysis of a prospective study involved infants ≤ 28 weeks gestation. Enrolled infants underwent lung ultrasound assessment on postnatal days 3, 7 and 14, measuring LUS. EWC was computed on the same time points. Infants were classified as either having BPD or not. Descriptive statistics, correlation coefficient, and area under the receiver operating characteristic (AUROC) curve analysis were utilized. Of 132 infants, 70 (53%) had BPD. Univariate analysis revealed statistically significant differences in LUS and EWC at days 3, 7, and 14 between BPD and no-BPD groups (p < 0.001). A statistically significant but weak positive correlation existed between LUS and EWC (r0.37, r0.29, r0.24, and p < 0.01) at postnatal days 3, 7, and 14, respectively. AUROC analysis indicated LUS having superior predictive capacity for the need for invasive mechanical ventilation at day 14 as well as the later BPD development compared to EWC (p < 0.0001). CONCLUSION In a cohort of extreme preterm infants, our study revealed a positive yet weak correlation between LUS and EWC, suggesting that EWC was not the major contributing to the evolving chronic lung disease. WHAT IS KNOWN • Recent evidence links Early Weight-Changes with bronchopulmonary dysplasia in preterm neonates. • Lung ultrasound score has shown promise in early prediction of the subsequent development of bronchopulmonary dysplasia in preterm infants. No studies have examined the correlation between Early Weight-Changes and Lung ultrasound score in preterm infants during first 2 weeks after birth. WHAT IS NEW • Our study demonstrated a positive and statistically significant correlation between early LUS and EWC, indicating their potential role as early predictors for the subsequent development of BPD in extreme preterm infants. • The weak correlation between the two parameters may stem from the possible restricted influence of EWC, given that it may not be the primary factor contributing to the evolving chronic lung disease.
Collapse
Affiliation(s)
- Mohab Ghanem
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, ON, M5G 1X5, Canada
| | - Carlos Zozaya
- Department of Neonatology, Hospital Universitario La Paz, Madrid, Spain
| | - Jenna Ibrahim
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, ON, M5G 1X5, Canada
| | - Seungwoo Lee
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, ON, M5G 1X5, Canada
| | - Nada Mohsen
- Department of Pediatrics, Mansoura University, Mansoura, Egypt
| | - Nehad Nasef
- Department of Pediatrics, Mansoura University, Mansoura, Egypt
| | - Adel Mohamed
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, ON, M5G 1X5, Canada.
| |
Collapse
|
3
|
Valentine GC, Perez KM, Wood TR, Mayock DE, Law JB, Kolnik S, Strobel KM, Brandon OC, Comstock BA, Heagerty PJ, Juul SE. Time to regain birthweight and association with neurodevelopmental outcomes among extremely preterm newborns. J Perinatol 2024; 44:554-560. [PMID: 38195922 DOI: 10.1038/s41372-024-01869-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/16/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Determine association between time to regain birthweight and 2-year neurodevelopment among extremely preterm (EP) newborns. STUDY DESIGN Secondary analysis of the Preterm Erythropoietin Neuroprotection Trial evaluating time to regain birthweight, time from birth to weight nadir, time from nadir to regain birthweight, and cumulative weight loss with 2-year corrected Bayley Scales of Infant and Toddler Development 3rd edition. RESULTS Among n = 654 EP neonates, those with shorter nadir-to-regain had lower cognitive scores (≤1 day versus ≥8 days: -5.0 points, [CI -9.5, -0.6]) and lower motor scores (≤1 day versus ≥8 days: -4.6 points [CI -9.2, -0.03]) in adjusted stepwise forward regression modeling. Increasingly cumulative weight loss was associated with lower cognitive scores (≤-50 percent-days: -5.6, [CI -9.4, -1.8]), motor scores (≤-50 percent-days: -4.2, [CI -8.2, -0.2]); and language scores (≤-50 percent-days: -6.0, [CI -10.1, -1.9]). CONCLUSION Faster nadir-to-regain and excessive cumulative weight loss are associated with adverse 2-year neurodevelopmental outcomes. TRIAL REGISTRATION PENUT Trial Registration: NCT01378273. https://clinicaltrials.gov/ct2/show/NCT01378273 . CLINICAL TRIAL REGISTRATION This study is a post-hoc secondary analysis of pre-existing data from the PENUT Trial (NCT #01378273).
Collapse
Affiliation(s)
- Gregory C Valentine
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA.
- Division of Maternal-Fetal Medicine at Baylor College of Medicine, Department of Obstetrics & Gynecology, Houston, TX, USA.
| | - Krystle M Perez
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
| | - Thomas R Wood
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
| | - Dennis E Mayock
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
| | - Janessa B Law
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
| | - Sarah Kolnik
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
| | - Katie M Strobel
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
| | - Olivia C Brandon
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
| | - Bryan A Comstock
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Sandra E Juul
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
- Institute on Human Development and Disability, University of Washington, Seattle, WA, USA
| |
Collapse
|
4
|
Valentine G, Perez K, Wood T, Mayock D, Law J, Kolnik S, Strobel K, Brandon O, Comstock B, Heagerty P, Juul S. Time to Regain Birthweight and Association with Neurodevelopmental Outcomes among Extremely Preterm Newborns. RESEARCH SQUARE 2023:rs.3.rs-3249598. [PMID: 37790304 PMCID: PMC10543289 DOI: 10.21203/rs.3.rs-3249598/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Objective Determine association between time to regain birthweight and 2-year neurodevelopment among extremely preterm (EP) newborns. Study Design Secondary analysis of the Preterm Erythropoietin Neuroprotection Trial evaluating time to regain birthweight, time from birth to weight nadir, time from nadir to regain birthweight, and cumulative weight loss with 2-year corrected Bayley Scales of Infant and Toddler Development 3rd edition. Results Among n = 654 EP neonates, those with shorter nadir-to-regain had lower cognitive scores (2-4 days versus ≥ 8 days: -3.5, [CI -7.0, 0.0]; ≤1 day versus ≥ 8 days: -5.0, [CI -10.2, 0.0]) in fully adjusted stepwise forward regression modeling. Increasingly cumulative weight loss was associated with lower cognitive scores (-50 to <-23 percent-days: -4.0, [95% CI -7.6, -0.4]) and language scores (≤-50 percent-days: -5.7, [CI -9.8, -1.6]; -50 to <-23 percent-days: -6.1, [CI -10.2, -2.0]). Conclusion Faster nadir-to-regain and prolonged, severe weight loss are associated with adverse 2-year neurodevelopmental outcomes. Trial registration PENUT Trial Registration: NCT01378273. https://clinicaltrials.gov/ct2/show/NCT01378273.
Collapse
Affiliation(s)
| | | | | | | | | | - Sarah Kolnik
- University of Washington - Seattle Children's Hospital
| | | | | | | | | | | |
Collapse
|
5
|
Valentine GC, Perez K, Hair AB. Early Fluid and Nutritional Management of Extremely Preterm Newborns During the Fetal-To-Neonatal Transition. Clin Perinatol 2023; 50:545-556. [PMID: 37536763 DOI: 10.1016/j.clp.2023.04.002] [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: 08/05/2023]
Abstract
During the fetal-to-neonatal transitional period, extremely preterm newborns undergo significant intrabody fluid shifts and resulting weight loss due to increased insensible fluid losses due to immature skin, kidneys, among other factors. These ongoing physiologic changes make fluid and nutritional management complex in the neonatal-to-fetal transitional time period for extremely premature newborns. However, limited literature exists to guide optimal practices for providers caring for this population. Here, we review the evidence on optimal fluid and nutritional management during the fetal-to-neonatal transition of extremely preterm newborns.
Collapse
Affiliation(s)
- Gregory C Valentine
- Division of Neonatology, Department of Pediatrics, University of Washington, Box 356320, RR542 HSB, Seattle, WA, USA.
| | - Krystle Perez
- Division of Neonatology, Department of Pediatrics, University of Washington, Box 356320, RR542 HSB, Seattle, WA, USA
| | - Amy B Hair
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin Street, Suite W6104, Houston, TX 77030, USA
| |
Collapse
|
6
|
Brandon OC, Perez KM, Kolnik SE, Juul SE, Wood TR, Valentine GC. Increasing Sodium Variability in the First 96 Hours after Birth is Associated with Adverse In-Hospital Outcomes of Preterm Newborns. Curr Dev Nutr 2023; 7:100026. [PMID: 37181132 PMCID: PMC10100926 DOI: 10.1016/j.cdnut.2022.100026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/22/2022] [Accepted: 12/15/2022] [Indexed: 12/28/2022] Open
Abstract
Background Neonatal intraventricular hemorrhage prevention bundles for preterm infants commonly defer daily weighing for the first 72 h, with reweighing occurring on day 4. Clinicians rely on maintaining stable sodium values as a proxy of fluid status to inform fluid management decisions over the first 96 h after birth. Yet, there exists a paucity of research evaluating whether serum sodium or osmolality are appropriate proxies for weight loss and whether increasing variability in sodium or osmolality during this early transitional period is associated with adverse in-hospital outcomes. Objectives To evaluate whether serum sodium or osmolality change in the first 96 h after birth was associated with percent weight change from birth weight, and to assess potential associations between serum sodium and osmolality variability with in-hospital outcomes. Methods This retrospective, cross-sectional study included neonates born at ≤30 gestational weeks or ≤1250 g. We evaluated associations between serum sodium coefficient of variation (CoV), osmolality CoV, and maximal weight loss percentage in the first 96 h after birth with in-hospital neonatal outcomes. Results Among 205 infants, serum sodium and osmolality were poorly correlated with percent weight change in individual 24-h increments (R2 = 0.01-0.14). For every 1% increase in sodium CoV, there was an associated 2-fold increased odds of surgical necrotizing enterocolitis and 2-fold increased odds of in-hospital mortality (odds ratio, 2.07; 95% CI: 1.02, 4.54; odds ratio, 1.95; 95% CI: 1.10, 3.64, respectively). Sodium CoV was more strongly associated with outcomes than absolute sodium maximal change. Conclusions In the first 96 h, serum sodium and osmolality are poor proxies for assessing percent weight change. Increasing variability of serum sodium is associated with later development of surgical necrotizing enterocolitis and all-cause in-hospital mortality. Prospective research is needed to evaluate whether reducing sodium variability in the first 96 h after birth, as assessed by CoV, improves newborn health outcomes.
Collapse
Affiliation(s)
- Olivia C. Brandon
- Division of Neonatology, University of Washington/Seattle Children’s Hospital, Seattle, WA, USA
| | - Krystle M. Perez
- Division of Neonatology, University of Washington/Seattle Children’s Hospital, Seattle, WA, USA
| | - Sarah E. Kolnik
- Division of Neonatology, University of Washington/Seattle Children’s Hospital, Seattle, WA, USA
| | - Sandra E. Juul
- Division of Neonatology, University of Washington/Seattle Children’s Hospital, Seattle, WA, USA
- Center on Human Development and Disability, University of Washington, Seattle, WA, USA
| | - Thomas R. Wood
- Division of Neonatology, University of Washington/Seattle Children’s Hospital, Seattle, WA, USA
| | - Gregory C. Valentine
- Division of Neonatology, University of Washington/Seattle Children’s Hospital, Seattle, WA, USA
- Department of Obstetrics & Gynecology at Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
7
|
Weaver LJ, Travers CP, Ambalavanan N, Askenazi D. Neonatal fluid overload-ignorance is no longer bliss. Pediatr Nephrol 2023; 38:47-60. [PMID: 35348902 PMCID: PMC10578312 DOI: 10.1007/s00467-022-05514-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/26/2022] [Accepted: 02/21/2022] [Indexed: 01/10/2023]
Abstract
Excessive accumulation of fluid may result in interstitial edema and multiorgan dysfunction. Over the past few decades, the detrimental impact of fluid overload has been further defined in adult and pediatric populations. Growing evidence highlights the importance of monitoring, preventing, managing, and treating fluid overload appropriately. Translating this knowledge to neonates is difficult as they have different disease pathophysiologies, and because neonatal physiology changes rapidly postnatally in many of the organ systems (i.e., skin, kidneys, and cardiovascular, pulmonary, and gastrointestinal). Thus, evaluations of the optimal targets for fluid balance need to consider the disease state as well as the gestational and postmenstrual age of the infant. Integration of what is known about neonatal fluid overload with individual alterations in physiology is imperative in clinical management. This comprehensive review will address what is known about the epidemiology and pathophysiology of neonatal fluid overload and highlight the known knowledge gaps. Finally, we provide clinical recommendations for monitoring, prevention, and treatment of fluid overload.
Collapse
Affiliation(s)
| | - Colm P Travers
- University of Alabama at Birmingham, Birmingham, AL, USA.
| | | | - David Askenazi
- University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
8
|
Durham L, Gunawan E, Nguyen K, Reeves A, Shukla V, Salas AA. Total Fluid Administration and Weight Loss during the First 2 Weeks in Infants Randomized to Early Enteral Feeding after Extremely Preterm Birth. Neonatology 2022; 120:257-262. [PMID: 36442467 PMCID: PMC10038856 DOI: 10.1159/000527430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Randomized trials have not reported the effects of the early progression of feeding volumes on fluid balance and neurodevelopment among infants born extremely preterm (≤28 weeks). METHOD Fluid, electrolyte, and neurodevelopment data of 60 extremely preterm infants randomly assigned to receive either 1 (early feeding group) or 4 days (late feeding group) of trophic feeding volumes at 20-24 mL/kg/day were analyzed. RESULTS Infants randomized to the early feeding group received less parenteral fluids, generated lower urine volumes, and had less excessive weight loss during the first 14 days after birth. The 7-point difference in cognitive scores and the 0.5 difference in weight-for-age z-scores favoring the early feeding group did not reach statistical significance. CONCLUSIONS In extremely preterm infants, early enteral feeding is associated with less total fluid administration and with less excessive weight loss during the first 2 weeks after birth. These short-term effects could have long-lasting benefits.
Collapse
Affiliation(s)
- Leandra Durham
- Department of Pediatrics/School of Medicine/University of Alabama at Birmingham/Birmingham, (AL,) USA
| | - Emily Gunawan
- Department of Pediatrics/School of Medicine/University of Alabama at Birmingham/Birmingham, (AL,) USA
| | - Kelly Nguyen
- Department of Pediatrics/School of Medicine/University of Alabama at Birmingham/Birmingham, (AL,) USA
| | - Audrey Reeves
- Department of Pediatrics/School of Medicine/University of Alabama at Birmingham/Birmingham, (AL,) USA
| | - Vivek Shukla
- Department of Pediatrics/School of Medicine/University of Alabama at Birmingham/Birmingham, (AL,) USA
| | - Ariel A. Salas
- Department of Pediatrics/School of Medicine/University of Alabama at Birmingham/Birmingham, (AL,) USA
| |
Collapse
|
9
|
Valentine GC, Perez KM, Wood TR, Mayock DE, Comstock BA, Puia-Dumitrescu M, Heagerty PJ, Juul SE. Postnatal maximal weight loss, fluid administration, and outcomes in extremely preterm newborns. J Perinatol 2022; 42:1008-1016. [PMID: 35338252 DOI: 10.1038/s41372-022-01369-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/31/2022] [Accepted: 03/10/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Evaluate maximal weight loss (MWL) and total fluid administration (TFA) association in first week after birth with outcomes among extremely preterm (EP) newborns. STUDY DESIGN We performed a retrospective analysis of the Preterm Erythropoietin Neuroprotection Trial evaluating first-week MWL, TFA, and association with in-hospital outcomes. RESULTS Among n = 883 included EP neonates, n = 842 survived ≥ 7 days and were included in outcome analyses. MWL between 5% to 15% was associated with decreased odds of necrotizing enterocolitis compared to MWL > 15% (OR 0.49, 95% CI 0.25-0.98). Average TFA > 150 mL/kg birthweight/day was associated with increased odds of necrotizing enterocolitis (OR 3.22, 95% CI 1.40-7.42) and patent ductus arteriosus requiring surgery (OR 2.14, 95% CI 1.10-4.15). CONCLUSION MWL between 5% to 15% is a potentially optimal window of MWL. Increasing average TFA in the first week is associated with adverse neonatal outcomes. Prospective studies evaluating MWL and TFA and relationship to outcomes in EP neonates are needed. CLINICAL TRIAL REGISTRATION This study is a secondary analysis of pre-existing data from the PENUT Trial Registration: NCT01378273, https://clinicaltrials.gov/ct2/show/NCT01378273 .
Collapse
Affiliation(s)
- Gregory C Valentine
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA. .,Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine at Baylor College of Medicine, Houston, TX, USA.
| | - Krystle M Perez
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
| | - Thomas R Wood
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
| | - Dennis E Mayock
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
| | - Bryan A Comstock
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Mihai Puia-Dumitrescu
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
| | | | - Sandra E Juul
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA.,Center on Human Development and Disability, University of Washington, Seattle, WA, USA
| |
Collapse
|
10
|
Zozaya C, Aziz K, Singhal N, Ye XY, Drolet C, Emberley J, Lee KS, Shah VS. Association of Weight Changes by Three Days after Birth and Mortality and/or Severe Neurological Injury in Preterm Infants < 29 Weeks Gestational Age: A Multicenter Cohort Study. CHILDREN 2022; 9:children9020276. [PMID: 35204996 PMCID: PMC8870872 DOI: 10.3390/children9020276] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/13/2022] [Accepted: 02/13/2022] [Indexed: 11/16/2022]
Abstract
Objective: This study aimed to determine the range of weight loss, at 3 days postnatal age, associated with the lowest risk of mortality/short-term morbidity in preterm infants <29 weeks gestational age (GA). Study design: This multicenter retrospective cohort study employed data from the Canadian Neonatal Network database. The primary outcome was a composite of mortality and/or severe neurological injury. Multivariable quadratic and linear regression models which adjusted for potential confounders were built. Results: A total of 9275 preterm infants (median GA 26, IQR 25, 28 weeks) were included. The optimal weight change range at day three, after adjustment for potential confounders for the primary outcomes, was −15 to −8.9%. Conclusions: There is a ‘U’-shaped relationship between weight change from birth to day three and mortality and/or severe neurological injury. Interventional studies, which target weight loss within the range found in this study and evaluate the impact on neonatal outcomes, are needed to corroborate our findings.
Collapse
Affiliation(s)
- Carlos Zozaya
- Department of Paediatrics, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada;
| | - Khalid Aziz
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada;
| | - Nalini Singhal
- Department of Pediatrics, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Xiang Y. Ye
- Maternal-Infant Care (MiCare) Research Centre, Mount Sinai Hospital, Toronto, ON M5G 1X6, Canada;
| | - Christine Drolet
- Centre Mère-Enfant Soleil, Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, QC G1V 4G2, Canada;
| | - Julie Emberley
- Department of Pediatrics, Janeway Children’s Health and Rehabilitation Center, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada;
| | - Kyong-Soon Lee
- Division of Neonatology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | - Vibhuti S. Shah
- Department of Paediatrics, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada;
- Correspondence: ; Tel.: +416-586-4816; Fax: +416-586-8745
| | | |
Collapse
|
11
|
Villalón H, Fernández MI, Larraín M, Quevedo J, Silva C, Pinto M. BALANCE Y FLUIDOS EN EL EXTREMO PREMATURO MENOR A 1000 GRAMOS DURANTE LA PRIMERA SEMANA DE VIDA: UNA ESTRATEGIA SIMPLIFICADA DE CÁLCULOS. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [DOI: 10.1016/j.rmclc.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
12
|
Fluid status in the first 10 days of life and death/bronchopulmonary dysplasia among preterm infants. Pediatr Res 2021; 90:353-358. [PMID: 33824447 DOI: 10.1038/s41390-021-01485-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/22/2021] [Accepted: 03/10/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate the association between fluid and sodium status in the first 10 postnatal days and death/bronchopulmonary dysplasia (BPD) among infants born <29 weeks' gestation. STUDY DESIGN Single center retrospective cohort study (2015-2018) of infants born 23-28 weeks'. Three exposure variables were evaluated over the first 10 postnatal days: cumulative fluid balance (CFB), median serum sodium concentration, and maximum percentage weight loss. Primary outcome was death and/or BPD. Multivariable logistic regression adjusting for patient covariates was used to assess the association between exposure variables and outcomes. RESULTS Of 191 infants included, 98 (51%) had death/BPD. Only CFB differed significantly between BPD-free survivors and infants with death/BPD: 4.71 dL/kg (IQR 4.10-5.12) vs 5.11 dL/kg (IQR 4.47-6.07; p < 0.001). In adjusted analyses, we found an association between higher CFB and higher odds of death/BPD (AOR 1.56, 95% CI 1.11-2.25). This was mainly due to the association of CFB with BPD (AOR 1.60, 95% CI 1.12-2.35), rather than with death (AOR 1.08, 95% CI 0.54-2.30). CONCLUSION Among preterm infants, a higher CFB in the first 10 days after delivery is associated with higher odds of death/BPD. IMPACT Previous studies suggest that postnatal fluid status influences survival and respiratory function in neonates. Fluid balance, serum sodium concentration, and daily weight changes are commonly used as fluid status indicators in neonates. We found that higher cumulative fluid balance in the first 10 days of life was associated with higher odds of death/bronchopulmonary dysplasia in neonates born <29 weeks. Monitoring of postnatal fluid balance may be an appropriate non-invasive strategy to favor survival without bronchopulmonary dysplasia. We developed a cumulative fluid balance chart with corresponding thresholds on each day to help design future trials and guide clinicians in fluid management.
Collapse
|
13
|
Valentine GC, Umoren RA, Perez KM. Early inadequate or excessive weight loss: A potential contributor to mortality in premature newborns in resource-scarce settings? Pediatr Neonatol 2021; 62:237-239. [PMID: 33678594 DOI: 10.1016/j.pedneo.2021.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/08/2020] [Accepted: 01/19/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Gregory C Valentine
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA, USA; Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX, USA.
| | - Rachel A Umoren
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Krystle M Perez
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| |
Collapse
|
14
|
Individualized fluid management in extremely preterm neonates to ensure adequate diuresis without increasing complications. J Perinatol 2021; 41:240-246. [PMID: 32814823 DOI: 10.1038/s41372-020-00789-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/06/2020] [Accepted: 08/07/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Decrease the incidence of inadequate diuresis (ID, loss of <6% of birth weight) in extremely preterm neonates (EPT, <28 weeks of gestation at birth) during the first week of life by 50% in 1 year. STUDY DESIGN Quality improvement project in a level IV neonatal intensive care unit. A fluid management protocol was implemented, including the use of a fluid guide sheet and closer monitoring of hydration parameters. Seventy-nine baseline EPT neonates were compared to 83 post intervention. The incidence of ID was tracked monthly, along with prespecified morbidities and complications. Statistical data analyses also compared the pre- and post-intervention periods. RESULTS Fluid volumes in the first week were decreased (p < 0.001). ID decreased from 43 to 29% (p = 0.061). Tracked morbidities and complications were not statistically different. CONCLUSION Intentional and individualized adjustment of fluids led to decreased ID without increased hypernatremia and dehydration, or a change in tracked morbidities.
Collapse
|
15
|
Belin CHS, Sarmento RA, Refosco LF, Bernardi JR. Description of a Nutrition Screening and Assessment Tool and Associations with Clinical Outcomes in Preterm Newborns. Nutr Clin Pract 2021; 36:1252-1261. [PMID: 33410545 DOI: 10.1002/ncp.10618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Preterm newborns have higher nutrition risk and mortality. Nutrition risk screening enables early intervention. This article evaluates a nutrition screening tool in a neonatal intensive care unit (NICU). METHOD Retrospective longitudinal study of preterm newborns (aged <37 weeks) in a NICU in Brazil from May 2018 to January 2019. Weight, length, and head circumference (HC) were analyzed. Nutrition screening was defined by care levels (CLs). Outcomes analyzed were bronchopulmonary dysplasia (BPD), peri-intraventricular hemorrhage (PIVH), retinopathy of prematurity (ROP), late sepsis, length of stay, mortality, and time receiving enteral and parenteral nutrition. RESULTS Data on 110 newborns were studied, with median gestational age 34 (31-35) weeks, mean weight 1914.92 g (±657.7), length 42.2 cm (±4.45), and HC 29.9 cm (±2.97). Most (82.7%) of them were adequate for gestational age. Screening classifications were 41.8% (n = 46) at CL 2, 41.8% (n = 46) at CL 3, and 16.4% (n = 18) at CL 4. CL 3 and CL 4 patients had higher frequencies of BPD (P = .003), ROP (P = .027), and PIVH (P = .006) and longer enteral time (P < .001) and length of stay (P < .001). All mortality occurred in CL 4 patients (P < .001). CONCLUSIONS CL 3 and CL 4 patients had more BPD, ROP, PIVH, and mortality and longer enteral nutrition. Hospital stay was longer for CL ≥3 than CL 2 patients. Patients classified as CL 3 and CL 4 by the nutrition screening tool may have higher nutrition risk.
Collapse
Affiliation(s)
- Christy Hannah Sanini Belin
- Child and Adolescent Health Program, Department of Nutrition, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Nutrition and Dietetic Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Roberta Aguiar Sarmento
- Nutrition and Dietetic Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lília Farret Refosco
- Nutrition and Dietetic Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Juliana Rombaldi Bernardi
- Child and Adolescent Health Program, Food, Nutrition and Health Program, Department of Nutrition, Medical School, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|
16
|
Alburaki W, Yusuf K, Dobry J, Sheinfeld R, Alshaikh B. High Early Parenteral Lipid in Very Preterm Infants: A Randomized-Controlled Trial. J Pediatr 2021; 228:16-23.e1. [PMID: 32798567 DOI: 10.1016/j.jpeds.2020.08.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/02/2020] [Accepted: 08/10/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine whether high early parenteral soybean oil lipid intake in very low birth weight (VLBW) infants in the first week after birth decreases the proportion of weight loss and subsequently the incidence of extrauterine growth restriction (EUGR). STUDY DESIGN This was a randomized controlled trial of appropriate for gestational- ge VLBW infants. Lipid intake in the control group started at 0.5-1 g/kg per day and increased daily by 0.5-1 g/kg per day till reaching 3 g/kg per day. The intervention group was started on 2 g/kg per day that increased to 3 g/kg per day the following day. RESULTS Of the 176 infants assessed for eligibility, 83 were included in the trial. Infants in the intervention group were started on lipid sooner (13.8 ± 7.8 vs 17.5 ± 7.8 hour; P = .03) and had higher cumulative lipid intake in the first 7 days of age (13.5 ± 4.2 vs 10.9 ± 3.5 g/kg per day; P = .03). Infants in the intervention group had a lower percentage of weight loss (10.4 vs 12.7%; P = .02). The mean triglyceride level was higher in the intervention group (1.91 ± 0.79 vs 1.49 ± 0.54 mmol/L; P = .01), however, hypertriglyceridemia was similar between the 2 groups. The incidence of EUGR was lower in the intervention group (38.6% vs 67.6%; P = .01). Head circumference z score was higher in the intervention group (-1.09 ± 0.96 vs -1.59 ± 0.98; P = .04). CONCLUSIONS In VLBW infants, provision of a high early dose of parenteral lipid in the first week of age results in less weight loss and lower incidence of EUGR. TRIAL REGISTRATION Clinicaltrials.gov: NCT03594474.
Collapse
Affiliation(s)
- Wissam Alburaki
- Neonatal Nutritional and Gastroenterology Program, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Kamran Yusuf
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Jenna Dobry
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Rachel Sheinfeld
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Belal Alshaikh
- Neonatal Nutritional and Gastroenterology Program, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
| |
Collapse
|
17
|
Bae SP, Song JH, Hahn WH, Koh JW, Kim H. Perinatal Risk Factors for Postnatal Weight Loss in Late Preterm Infants. NEONATAL MEDICINE 2019. [DOI: 10.5385/nm.2019.26.4.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|