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Nguyen TMT, Morwood H, Bakrania BA, Miller SM, Bjorkman ST, Lingwood BE, Wright IMR, Eiby YA. Blood volume reduction due to rapid plasma loss after birth in preterm piglets. Pediatr Res 2024:10.1038/s41390-024-03252-x. [PMID: 38773295 DOI: 10.1038/s41390-024-03252-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 02/21/2024] [Accepted: 03/24/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Understanding changes in blood volume after preterm birth is critical to preventing cardiovascular deterioration in preterm infants. The aims were to determine if blood volume is higher in preterm than term piglets and if blood volume changes in the hours after birth. METHODS Paired blood volume measurements were conducted in preterm piglets (98/115d gestation, ~28wk gestation infant) at 0.5-5 h (n = 12), 0.5-9 h (n = 44) and 5-11 h (n = 7) after birth, and in a term cohort at 0.5-9 h (n = 40) while under intensive care. RESULTS At 30 min after birth, blood volume was significantly lower in preterm piglets compared to term piglets. By 9 h after birth, blood volume had reduced by 18% in preterm piglets and 13% in term piglets. By 5-9 h after birth, preterm piglets had significantly lower blood volumes than at term (61 ± 10 vs. 76 ± 11 mL/kg). CONCLUSIONS In contrast to clinical resources, preterm piglets have a lower blood volume than at term. Substantial reductions in blood volume after birth leave some preterm piglets hypovolemic. If this also occurs in preterm infants, this may have important clinical consequences. Modern studies of blood volume changes after birth are essential for improving preterm outcomes. IMPACT Preterm piglets do not have a higher blood volume than their term counterparts, in contrast to current clinical estimates. Rapid reduction in blood volume after birth leads to hypovolemia in some preterm piglets. There is a critical need to understand blood volume changes after birth in preterm infants in order to improve clinical management of blood volume.
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Affiliation(s)
- Tam M T Nguyen
- Perinatal Research Centre and UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Holly Morwood
- Perinatal Research Centre and UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Bhavisha A Bakrania
- Perinatal Research Centre and UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Stephanie M Miller
- Perinatal Research Centre and UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Stella T Bjorkman
- Perinatal Research Centre and UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Barbara E Lingwood
- Perinatal Research Centre and UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Neonatology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Ian M R Wright
- Perinatal Research Centre and UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Australian Institute of Tropical Health and Medicine, The College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
| | - Yvonne A Eiby
- Perinatal Research Centre and UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
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2
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Forbes EM, Bakrania BA, Steane SE, Moritz KM, Lingwood BE, Eiby YA. Expression of TRPM6 and TRPM7 in the preterm piglet heart. Front Pediatr 2022; 10:891722. [PMID: 36081632 PMCID: PMC9445433 DOI: 10.3389/fped.2022.891722] [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: 03/08/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Preterm infants are at increased risk of death and disability, and cardiovascular instability after birth is a contributing factor. Immaturity of calcium handling in the preterm heart may limit myocardial contractility and cardiac output. Two transmembrane cation channels, TRPM6 and TRPM7, may regulate intracellular cardiac calcium in the neonatal period. The aim of this study was to determine TRPM6 and TRPM7 mRNA expression in piglet hearts in late gestation, and the effects of sex, maternal glucocorticoids, and the transition to extrauterine life. Left and right ventricular tissue was collected at a range of gestational ages from cesarean delivered piglets at birth and at 6 h old. Additional groups included piglets exposed to maternal glucocorticoid treatment and spontaneously born term piglets at 12-24 h old. TRPM6 and TRPM7 mRNA expression was measured using RT-qPCR. Males had significantly lower TRPM7 expression in the left ventricle across all gestational ages compared to females. At term, both ventricles had higher TRPM7 expression at 6 h old than at birth. In preterm piglets, TRPM7 expression only increased postnatally in the right ventricle following maternal glucocorticoid exposure. At 12-24 h old, TRPM7 expression in both ventricles was lower than levels in 6 h old term Caesar piglets (113 days). Male preterm piglets may have immature myocardial Ca2+ handling and this could contribute to their poorer outcomes. Increased TRPM7 expression is the mature response to birth that is missing in preterm neonates. TRPM7 could serve as a novel target to improve cardiac function in preterm neonates.
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Affiliation(s)
- Elizabeth M Forbes
- Queensland Children's Hospital, Brisbane, QLD, Australia.,UQ Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Bhavisha A Bakrania
- UQ Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Sarah E Steane
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Karen M Moritz
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Barbara E Lingwood
- UQ Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Yvonne A Eiby
- UQ Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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3
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Jebessa S, Litch JA, Senturia K, Hailu T, Kahsay A, Kuti KA, Wolka E, Teklu AM, Gezahegn W. Qualitative Assessment of the Quality of Care for Preterm, Low Birth Weight, and Sick Newborns in Ethiopia. Health Serv Insights 2021; 14:11786329211025150. [PMID: 34211278 PMCID: PMC8216415 DOI: 10.1177/11786329211025150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/21/2021] [Indexed: 11/16/2022] Open
Abstract
This study assesses the quality of care for preterm, low birth weight (LBW), and sick newborns across the public health care system levels in 3 regions of Ethiopia. Qualitative data based on the WHO framework to assess provision and experience of care was collected using in-depth interviews and focus group discussions with women who recently delivered preterm, LBW, and sick newborns, as well as health care providers and health extension workers, and facility administrators associated with study health facilities. This qualitative approach revealed perspectives of patients, health care providers and facility administrators to assess what is actually happening in facilities. Clinical guidelines for the care of preterm, LBW, and sick newborns were not available in many facilities, and even when available, often not followed. Most providers reported little or no communication with parents following hospital discharge. Human resource challenges (shortage of skilled staff, motivation and willingness, lack of supervision, and poor leadership) inhibited quality of care. Participants reported widespread shortages of equipment and supplies, medication, physical space, water, electricity, and infrastructure. Economic insecurity was a critical factor affecting parents’ experience. Acceptance by users was impacted by the perceived benefits and cost. Users reported they were less likely to accept interventions if they perceived that there would be financial costs they couldn’t afford. The quality of care for preterm, LBW, and sick newborns in Ethiopia as reported by recently delivered women, health care providers and facility administrators is compromised. Improving quality of care requires attention to process of care, experience of care, and health system capacity, structure, and resources.
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Affiliation(s)
- Solomie Jebessa
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - James A Litch
- Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), Lynnwood, WA, USA
| | - Kirsten Senturia
- Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), Lynnwood, WA, USA
| | | | | | | | | | - Alula M Teklu
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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4
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Sucre J, Haist L, Bolton CE, Hilgendorff A. Early Changes and Indicators Characterizing Lung Aging in Neonatal Chronic Lung Disease. Front Med (Lausanne) 2021; 8:665152. [PMID: 34136503 PMCID: PMC8200413 DOI: 10.3389/fmed.2021.665152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/04/2021] [Indexed: 12/16/2022] Open
Abstract
Infants suffering from neonatal chronic lung disease, i.e., bronchopulmonary dysplasia, are facing long-term consequences determined by individual genetic background, presence of infections, and postnatal treatment strategies such as mechanical ventilation and oxygen toxicity. The adverse effects provoked by these measures include inflammatory processes, oxidative stress, altered growth factor signaling, and remodeling of the extracellular matrix. Both, acute and long-term consequences are determined by the capacity of the immature lung to respond to the challenges outlined above. The subsequent impairment of lung growth translates into an altered trajectory of lung function later in life. Here, knowledge about second and third hit events provoked through environmental insults are of specific importance when advocating lifestyle recommendations to this patient population. A profound exchange between the different health care professionals involved is urgently needed and needs to consider disease origin while future monitoring and treatment strategies are developed.
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Affiliation(s)
- Jennifer Sucre
- Mildred Stahlman Division of Neonatology, Department of Pediatrics, Vanderbilt University, Nashville, TN, United States
| | - Lena Haist
- Institute for Lung Biology and Disease and Comprehensive Pneumology Center With the CPC-M bioArchive, Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany.,Center for Comprehensive Developmental Care (CDeCLMU), University Hospital Ludwig-Maximilian University, Munich, Germany
| | - Charlotte E Bolton
- Division of Respiratory Medicine, NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, City Hospital NUH Campus, Nottingham, United Kingdom
| | - Anne Hilgendorff
- Institute for Lung Biology and Disease and Comprehensive Pneumology Center With the CPC-M bioArchive, Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany.,Center for Comprehensive Developmental Care (CDeCLMU), University Hospital Ludwig-Maximilian University, Munich, Germany
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5
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Dahl MJ, Veneroni C, Lavizzari A, Bowen S, Emerson H, Rebentisch A, Dawson E, Summers K, Pettet L, Wang Z, Null DM, Yoder BA, Dellacà RL, Albertine KH. Early extubation to noninvasive respiratory support of former preterm lambs improves long-term respiratory outcomes. Am J Physiol Lung Cell Mol Physiol 2021; 321:L248-L262. [PMID: 34009031 DOI: 10.1152/ajplung.00051.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Invasive mechanical ventilation (IMV) and exposure to oxygen-rich gas during early postnatal life are contributing factors for long-term pulmonary morbidities faced by survivors of preterm birth and bronchopulmonary dysplasia. The duration of IMV that leads to long-term pulmonary morbidities is unknown. We compared two durations of IMV (3 h vs. 6 days) during the first 6-7 days of postnatal life in preterm lambs to test the hypothesis that minimizing the duration of IMV will improve long-term respiratory system mechanics and structural outcomes later in life. Moderately preterm (∼85% gestation) lambs were supported by IMV for either 3 h or 6 days before weaning from all respiratory support to become former preterm lambs. Respiratory system mechanics and airway reactivity were assessed monthly from 1 to 6 mo of chronological postnatal age by the forced oscillation technique. Quantitative morphological measurements were made for smooth muscle accumulation around terminal bronchioles and indices of alveolar formation. Minimizing IMV to 3 h led to significantly better (P < 0.05) baseline respiratory system mechanics and less reactivity to methacholine in the first 3 mo of chronological age (2 mo corrected age), significantly less (P < 0.05) accumulation of smooth muscle around peripheral resistance airways (terminal bronchioles), and significantly better (P < 0.05) alveolarization at the end of 5 mo corrected age compared with continuous IMV for 6 days. We conclude that limiting the duration of IMV following preterm birth of fetal lambs leads to better respiratory system mechanics and structural outcomes later in life.
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Affiliation(s)
- Mar Janna Dahl
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Chiara Veneroni
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milan, Italy
| | - Anna Lavizzari
- U.O. di Neonatologia e Terapia Intensiva Neonatale, Department of Clinical Sciences and Community Health, University of Milan Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sydney Bowen
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Haleigh Emerson
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Andrew Rebentisch
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Elaine Dawson
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Kyle Summers
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Luke Pettet
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Zhengming Wang
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Donald M Null
- Division of Neonatology, University of California, Davis, California
| | - Bradley A Yoder
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Raffaele L Dellacà
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milan, Italy
| | - Kurt H Albertine
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
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6
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Caesar R, Colditz PB, Cioni G, Boyd RN. Clinical tools used in young infants born very preterm to predict motor and cognitive delay (not cerebral palsy): a systematic review. Dev Med Child Neurol 2021; 63:387-395. [PMID: 33185285 DOI: 10.1111/dmcn.14730] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 12/27/2022]
Abstract
AIM This systematic review evaluates the accuracy of clinical tools used at a corrected age of 6 months or younger to predict motor and cognitive delay (not cerebral palsy) at 24 months' corrected age, in infants born very preterm. METHOD Six databases were searched. Quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool. Predictive analysis included calculation of sensitivity and specificity, inspection of summary receiver operating characteristics curves, and bivariate meta-analysis. RESULTS Six assessments were identified in 10 studies of 992 infants. Overall prevalence of motor delay was 13.8% and cognitive delay was 11.7%. Methodological quality was variable for patient selection, reference standard, flow, and timing. All studies had a low risk of bias for the index test. General Movement Assessment (GMA) predicted motor and cognitive outcomes with good accuracy for mild, moderate, and severe delays (fidgety age: pooled diagnostic odds ratio=12.3 [5.9-29.8]; hierarchical summary receiver operating characteristics curve=0.733). The Hammersmith Infant Neurological Examination (HINE) demonstrated excellent predictive accuracy for severe motor delay (3mo and 6mo; sensitivity 93% [68-100%], specificity 100% [96-100%]) but showed limited ability to predict milder delays. INTERPRETATION In the population of infants born very preterm, few assessment tools used at 6 months or younger corrected age have proven predictive accuracy for cognitive and motor delay at 24 months' corrected age. Only the GMA and HINE demonstrated useful predictive validity. WHAT THIS PAPER ADDS General movements have predictive validity for both motor and cognitive dysfunction in infants born very preterm. The Hammersmith Infant Neurological Examination showed the highest predictive accuracy for severe motor delay. The General Movement Assessment was the best tool to predict mild-to-moderate motor and cognitive delays.
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Affiliation(s)
- Rebecca Caesar
- Allied Health Women's and Families Service, Sunshine Coast Hospital and Health Service District, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia.,Faculty of Medicine, Child Health Research Centre, Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Paul B Colditz
- Faculty of Medicine, Child Health Research Centre, Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | - Giovanni Cioni
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy
| | - Roslyn N Boyd
- Faculty of Medicine, Child Health Research Centre, Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
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7
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Doubova SV, Josefa-García H, Coronado-Zarco IA, Carrera-Muiños S, Cordero-Gonzalez G, Cruz-Reynoso L, Mateos-Sanchez L, Maya-García AJ, Pérez-Cuevas R. Evaluating the quality of the processes of care and clinical outcomes of premature newborns admitted to neonatal intensive care units in Mexico. Int J Qual Health Care 2019; 30:608-617. [PMID: 29722867 DOI: 10.1093/intqhc/mzy061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 03/20/2018] [Indexed: 11/12/2022] Open
Abstract
Objectives To develop quality of care (QoC) indicators, evaluate the quality of the processes of care (QPC) and clinical outcomes, and analyze the association between the QPC and severe clinical outcomes of preterm newborns admitted to neonatal intensive care units (NICUs). Design Mixed methods approach: (1) development of QoC indicators via modified RAND/UCLA method; (2) cross-sectional study of QoC evaluation and (3) multiple logistic regression analysis to ascertain the association between the QPC and severe clinical outcomes. Setting Two NICUs belonged to the Mexican Institute of Social Security in Mexico City. Participants About 489 preterm neonates (<37 weeks of gestation) without severe congenital anomalies. Main Outcome Measure(s) The QoC indicators; ≥60% of recommended QPC and severe clinical outcomes. Results The QoC included 10 QPC indicators across four domains: respiratory, nutrition and metabolism, infectious diseases, and screening, and five outcome indicators. The lower QPC indicators were for the nutrition and metabolism domain (17.8% started enteral feeding with human milk, and 20.7% received sodium bicarbonate appropriately). The higher QPC indicator was for the screening domain (97.6% of neonates <30 weeks gestation underwent early (≤14 days) transfontanelar ultrasound). The mean recommended QPC that neonates received was 47.5%. Only 26.6% of neonates received ≥60% of recommended QPC. About 60.7% of neonates developed severe clinical outcomes including mortality and healthcare-related major morbidity. Receiving ≥60% of recommended QPC was associated with a decrease of nearly half of odds of severe clinical outcomes. Conclusion The evaluation of the QoC in NICUs is essential to address modifiable gaps in quality.
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Affiliation(s)
- Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Heladia Josefa-García
- Unidad de Cuidados Intensivos Neonatales del Hospital de Pediatría del CMN Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Sandra Carrera-Muiños
- Unidad de Cuidados Intensivos Neonatales, Instituto Nacional de Perinatología, Mexico City, Mexico
| | | | - Leonardo Cruz-Reynoso
- División de pediatría, Hospital Gineco Obstetrica No 3 CMN 'LA RAZA', Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Leovigildo Mateos-Sanchez
- Unidad de Cuidados Intensivos Neonatales, Hospital de Gineco Obstetricia No. 4, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Ana Jesica Maya-García
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Ricardo Pérez-Cuevas
- Health System Research Center, National Institute of Public Health, Cuernavaca City, Mexico
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8
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Chiu TF, Yu TM, Chuang YW, Sun KT, Li CY, Su YC, Kao CH. Sequential risk of depression in children born prematurely: A nationwide population- based analysis. J Affect Disord 2019; 243:42-47. [PMID: 30223138 DOI: 10.1016/j.jad.2018.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/07/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Whether children born prematurely are at a high risk of depression is still unknown. The present study examined the risk of depression in children who were born prematurely, by analyzing a national cohort in Taiwan. METHODS All premature births between January 1, 2000, and December 31, 2010, by using the Taiwan National Health Insurance Research Database. A total of 21,478 preterm children and 85,903 full-term children were enrolled in this study. Sex, level of urbanization of residential area, and parental occupation were considered. We included participants who received a diagnosis of depression in more than two clinical visits or were hospitalized due to depression. RESULTS Preterm children had a 2.75-fold higher risk of depression than full-term children (95% confidence interval [CI] = 1.58-4.79, p < 0.001). Sex was not likely to be associated with depression in this study (p = 0.95). The lowest level of urbanization significantly contributed to the risk of depression in preterm children (adjusted hazard ratio = 6.8, 95% CI = 1.63-28.46, p < 0.01). Regarding parental occupation, preterm children whose parents had blue-collar and other occupations had a 3.4- and 6.06-fold higher risk of depression, respectively, compared with other children (blue-collar occupations: 95% CI = 1.04-11.15, p < 0.05; other occupations: 95% CI = 1.71-21.49, p < 0.01). CONCLUSIONS Preterm children had a 2.7-fold higher risk of depression than children born full-term. Early identification, timely psychiatric care, intervention strategies, and support for their families may reduce the complications of mental illness in preterm children.
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Affiliation(s)
- Ting-Fang Chiu
- Department of Pediatrics, Taipei City Hospital, Taipei, Taiwan
| | - Tung-Min Yu
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, No. 2 Yuh-Der-Road, Taichung 404, Taiwan; Division of Nephrology, Taichung Veterans General Hospital, Taiwan
| | - Ya-Wen Chuang
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, No. 2 Yuh-Der-Road, Taichung 404, Taiwan; Division of Nephrology, Taichung Veterans General Hospital, Taiwan
| | - Kuo-Ting Sun
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, No. 2 Yuh-Der-Road, Taichung 404, Taiwan; Pediatric Dentistry of Dental Department, China Medical University Hospital, Taichung, Taiwan
| | - Chi-Yuan Li
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, No. 2 Yuh-Der-Road, Taichung 404, Taiwan; Department of Anesthesiology, China Medical University Hospital, Taiwan
| | - Yuan-Chih Su
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, No. 2 Yuh-Der-Road, Taichung 404, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan; Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.
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9
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Abstract
Technological advances in neonatal-perinatal medicine have led to a steady increase in the survival of preterm infants. Although the increase in survival is a remarkable success, children born preterm remain at high risk for brain injury and long-term neurodevelopmental deficits. Children born preterm may have abnormal muscle tone or movements, cognitive deficits, language impairments, and behavioral problems. This article reviews neurodevelopmental outcomes and factors that influence outcomes in preterm children during early childhood.
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10
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Yin J, Wang X, Zhang L, Wang X, Liu H, Hu Y, Yan X, Tang Y, Wang J, Li Z, Yu Z, Cao Y, Han S. Peptidome analysis of lung tissues from a hyperoxia‐induced bronchopulmonary dysplasia mouse model: Insights into the pathophysiological process of bronchopulmonary dysplasia. J Cell Physiol 2018; 233:7101-7112. [PMID: 29741761 DOI: 10.1002/jcp.26633] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/30/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Jing Yin
- Department of Pediatrics, The Affiliated Obsterics and Gynecology Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, Jiangsu, China
| | - Xingyun Wang
- Department of Pediatrics, The Affiliated Obsterics and Gynecology Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, Jiangsu, China
- Nanjing Maternity and Child Health Care Institute, The Affiliated Obsterics and Gynecology Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, Jiangsu, China
| | - Le Zhang
- Department of Neonatology, Wuxi Children's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Xing Wang
- Nanjing Maternity and Child Health Care Institute, The Affiliated Obsterics and Gynecology Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, Jiangsu, China
| | - Heng Liu
- Department of Pediatrics, The Affiliated Obsterics and Gynecology Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, Jiangsu, China
| | - Yin Hu
- Department of Pediatrics, The Affiliated Obsterics and Gynecology Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, Jiangsu, China
| | - Xiangyun Yan
- Department of Pediatrics, The Affiliated Obsterics and Gynecology Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, Jiangsu, China
| | - Yongfeng Tang
- Department of Pediatrics, The Affiliated Obsterics and Gynecology Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, Jiangsu, China
| | - Juan Wang
- Department of Pediatrics, The First People's Hospital of Lianyungang City, Lianyungang, Jiangsu, China
| | - Zhengyin Li
- Department of Neonatology, Wuxi Children's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Zhangbin Yu
- Department of Pediatrics, The Affiliated Obsterics and Gynecology Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, Jiangsu, China
| | - Yan Cao
- Nanjing Maternity and Child Health Care Institute, The Affiliated Obsterics and Gynecology Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, Jiangsu, China
| | - Shuping Han
- Department of Pediatrics, The Affiliated Obsterics and Gynecology Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, Jiangsu, China
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11
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Islam UA, Poole KL, Schmidt LA, Ford J, Saigal S, Van Lieshout RJ. Childhood language skills and adolescent self-esteem in preterm survivors. J Child Health Care 2018; 22:34-45. [PMID: 29110533 DOI: 10.1177/1367493517739158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fifty-seven percent of children with poor language skills are affected by socio-emotional problems. Despite the importance of language skills to interpersonal functioning and school performance, relatively little is known about how they affect self-esteem in adolescence. Data on youth at high risk for language problems (e.g. those born extremely low birth weight (ELBW; <1000 grams)) are even more scarce. This prospective study examined associations between language skills at age 8 and self-esteem during adolescence (12-16 years) in individuals born at ELBW ( N = 138) or normal birth weight (NBW; >2500 grams) ( N = 111). Participants' language skills were assessed using the Verbal Scale of the Wechsler Intelligence Scale for Children-Revised and the Token Test at age 8. In adolescence, participants completed the Harter Self-Perception Profile for Adolescents. Birth weight status was found to moderate associations between childhood language and adolescent global self-esteem (Token Test ( p = .006), Verbal Intelligence Quotient ( p = .033)) such that better language skills were associated with higher self-esteem in adolescent ELBW survivors, but not in NBW participants. Language skills may play a protective role in the development and maintenance of self-esteem in ELBW youth and could be an important target for optimizing their functioning, particularly before transitioning to the critical adolescent period.
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Affiliation(s)
- Umna A Islam
- 1 Life Sciences Program, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Kristie L Poole
- 2 MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Louis A Schmidt
- 3 Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Ford
- 4 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Saroj Saigal
- 5 Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Ryan J Van Lieshout
- 4 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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12
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Feng Y, Zhou H, Zhang Y, Perkins A, Wang Y, Sun J. Comparison in executive function in Chinese preterm and full-term infants at eight months. Front Med 2017. [DOI: 10.1007/s11684-017-0540-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Mills DR, Mao Q, Chu S, Falcon Girard K, Kraus M, Padbury JF, De Paepe ME. Effects of human umbilical cord blood mononuclear cells on respiratory system mechanics in a murine model of neonatal lung injury. Exp Lung Res 2017; 43:66-81. [PMID: 28353351 DOI: 10.1080/01902148.2017.1300713] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Mononuclear cells (MNCs) have well-documented beneficial effects in a wide range of adult pulmonary diseases. The effects of human umbilical cord blood-derived MNCs on neonatal lung injury, highly relevant for potential autologous application in preterm newborns at risk for bronchopulmonary dysplasia (BPD), remain incompletely established. The aim of this study was to determine the long-term morphologic and functional effects of systemically delivered MNCs in a murine model of neonatal lung injury. MATERIALS AND METHODS MNCs from cryopreserved cord blood (1 × 106 cells per pup) were given intravenously to newborn mice exposed to 90% O2 from birth; controls received cord blood total nucleated cells (TNCs) or granular cells, or equal volume vehicle buffer (sham controls). In order to avoid immune rejection, we used SCID mice as recipients. Lung mechanics (flexiVent™), engraftment, growth, and alveolarization were evaluated eight weeks postinfusion. RESULTS Systemic MNC administration to hyperoxia-exposed newborn mice resulted in significant attenuation of methacholine-induced airway hyperreactivity, leading to reduction of central airway resistance to normoxic levels. These bronchial effects were associated with mild improvement of alveolarization, lung compliance, and elastance. TNCs had no effects on alveolar remodeling and were associated with worsened methacholine-induced bronchial hyperreactivity. Granular cell administration resulted in a marked morphologic and functional emphysematous phenotype, associated with high mortality. Pulmonary donor cell engraftment was sporadic in all groups. CONCLUSIONS These results suggest that cord blood MNCs may have a cell type-specific role in therapy of pulmonary conditions characterized by increased airway resistance, such as BPD and asthma. Future studies need to determine the active MNC subtype(s), their mechanisms of action, and optimal purification methods to minimize granular cell contamination.
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Affiliation(s)
- David R Mills
- a Department of Pathology , Women and Infants Hospital , Providence , Rhode Island , USA
| | - Quanfu Mao
- a Department of Pathology , Women and Infants Hospital , Providence , Rhode Island , USA.,b Department of Pathology and Laboratory Medicine , Alpert Medical School of Brown University , Providence , Rhode Island , USA
| | - Sharon Chu
- a Department of Pathology , Women and Infants Hospital , Providence , Rhode Island , USA.,b Department of Pathology and Laboratory Medicine , Alpert Medical School of Brown University , Providence , Rhode Island , USA
| | | | - Morey Kraus
- c ViaCord LLC, a Perkin Elmer Company , Cambridge , Massachusetts , USA
| | - James F Padbury
- d Department of Pediatrics , Women and Infants Hospital , Providence , Rhode Island , USA.,e Department of Pediatrics , Alpert Medical School of Brown University , Providence , Rhode Island , USA
| | - Monique E De Paepe
- a Department of Pathology , Women and Infants Hospital , Providence , Rhode Island , USA.,b Department of Pathology and Laboratory Medicine , Alpert Medical School of Brown University , Providence , Rhode Island , USA
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Abstract
Infants born at extreme preterm gestation are at risk for both death and disability. Although rates of survival have improved for this population, and some evidence suggests a trend toward decreased neuromotor impairment over the past decades, a significant improvement in overall early neurodevelopmental outcome has not yet been realized. This review will examine the rates and types of neurodevelopmental impairment seen after extremely preterm birth, including neurosensory, motor, cognitive, and behavioral outcomes. We focus on early outcomes in the first 18-36 months of life, as the majority of large neonatal studies examining neurodevelopmental outcomes stop at this age. However, this early age is clearly just a first glimpse into lifetime outcomes; the neurodevelopmental effects of extreme prematurity may last through school age, adolescence, and beyond. Importantly, prematurity appears to be an independent risk factor for adverse development, but this population demonstrates considerable variability in the types and severity of impairments. Understanding both the nature and prevalence of neurodevelopmental impairment among extremely preterm infants is important because it can lead to targeted interventions that in turn may lead to improved outcomes.
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Affiliation(s)
- Elizabeth E Rogers
- Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, 550 4th St, 5th Floor, Box 0743, San Francisco, CA 94143.
| | - Susan R Hintz
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Palo Alto, CA
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Progressive Vascular Functional and Structural Damage in a Bronchopulmonary Dysplasia Model in Preterm Rabbits Exposed to Hyperoxia. Int J Mol Sci 2016; 17:ijms17101776. [PMID: 27783043 PMCID: PMC5085800 DOI: 10.3390/ijms17101776] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/10/2016] [Accepted: 10/17/2016] [Indexed: 11/17/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is caused by preterm neonatal lung injury and results in oxygen dependency and pulmonary hypertension. Current clinical management fails to reduce the incidence of BPD, which calls for novel therapies. Fetal rabbits have a lung development that mimics humans and can be used as a translational model to test novel treatment options. In preterm rabbits, exposure to hyperoxia leads to parenchymal changes, yet vascular damage has not been studied in this model. In this study we document the early functional and structural changes of the lung vasculature in preterm rabbits that are induced by hyperoxia after birth. Pulmonary artery Doppler measurements, micro-CT barium angiograms and media thickness of peripheral pulmonary arteries were affected after seven days of hyperoxia when compared to controls. The parenchyma was also affected both at the functional and structural level. Lung function testing showed higher tissue resistance and elastance, with a decreased lung compliance and lung capacity. Histologically hyperoxia leads to fewer and larger alveoli with thicker walls, less developed distal airways and more inflammation than normoxia. In conclusion, we show that the rabbit model develops pulmonary hypertension and developmental lung arrest after preterm lung injury, which parallel the early changes in human BPD. Thus it enables the testing of pharmaceutical agents that target the cardiovascular compartment of the lung for further translation towards the clinic.
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Caesar R, Boyd RN, Colditz P, Cioni G, Ware RS, Salthouse K, Doherty J, Jackson M, Matthews L, Hurley T, Morosini A, Thomas C, Camadoo L, Baer E. Early prediction of typical outcome and mild developmental delay for prioritisation of service delivery for very preterm and very low birthweight infants: a study protocol. BMJ Open 2016; 6:e010726. [PMID: 27377633 PMCID: PMC4947748 DOI: 10.1136/bmjopen-2015-010726] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Over 80% of very preterm (<32 weeks) and very low birthweight (<1500 g) infants will have either typical development (TD) or mild developmental delay (MDD) in multiple domains. As differentiation between TD and MDD can be difficult, infants with MDD often miss opportunities for intervention. For many clinicians, the ongoing challenge is early detection of MDD without over servicing the population. This study aims to: (1) identify early clinical biomarkers for use in this population to predict and differentiate between TD and MDD at 24 months corrected age. (2) Determine the extent to which family and caregiver factors will contribute to neurodevelopmental and behavioural outcomes. METHODS AND ANALYSIS Participants will be a prospective cohort of 90 infants (<32 weeks and/or <1500 g). Between 34 weeks gestational age and 16 weeks post-term, infants will have a series of 5 neurological, neuromotor, neurobehavioural and perceptual assessments including General Movement Assessment at preterm, writhing and fidgety age. Primary caregivers will complete questionnaires to identify social risk, maternal depression and family strain. Extensive perinatal data will be collected from the medical record. At 24 months, corrected age (c.a) infants will be assessed using standardised tools including the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley III). Longitudinal trajectories of early assessment findings will be examined to determine any predictive relationship with motor and cognitive outcomes at 24 months c.a. Published data of a cohort of Australian children assessed with the Bayley III at 24 months c.a will provide a reference group of term-born controls. ETHICS Ethical approval has been obtained from the Queensland Children's Health Services Human Research Ethics Committee (HREC/13/QRCH/66), the University of Queensland (2013001019) and the Sunshine Coast Hospital and Health Service, SC-Research Governance (SSA/13/QNB/66). Publication of all study outcomes will be in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12614000480684; Pre-results.
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Affiliation(s)
- Rebecca Caesar
- Faculty of Medicine and Biomedical Science, School of Medicine, The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), South Brisbane, Queensland, Australia
- Sunshine Coast Hospital and Health Service, Allied Health Women's and Families, Nambour General Hospital, Nambour, Queensland, Australia
| | - Roslyn N Boyd
- Faculty of Medicine and Biomedical Science, School of Medicine, The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), South Brisbane, Queensland, Australia
| | - Paul Colditz
- Faculty of Health Sciences, The University of Queensland, The University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Giovani Cioni
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy
| | - Robert S Ware
- Faculty of Medicine and Biomedical Science, School of Medicine, The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), South Brisbane, Queensland, Australia
- University of Queensland, School of Population Health, Herston, Queensland, Australia
| | - Kaye Salthouse
- Sunshine Coast Hospital and Health Service, Allied Health Women's and Families, Nambour General Hospital, Nambour, Queensland, Australia
| | - Julie Doherty
- Sunshine Coast Hospital and Health Service, Allied Health Women's and Families, Nambour General Hospital, Nambour, Queensland, Australia
| | - Maxine Jackson
- Sunshine Coast Hospital and Health Service, Allied Health Women's and Families, Nambour General Hospital, Nambour, Queensland, Australia
| | - Leanne Matthews
- Sunshine Coast Hospital and Health Service, Allied Health Women's and Families, Nambour General Hospital, Nambour, Queensland, Australia
| | - Tom Hurley
- Department of Paediatrics, Sunshine Coast Hospital and Health Service, Nambour General Hospital, Nambour, Queensland, Australia
| | - Anthony Morosini
- Department of Paediatrics, Sunshine Coast Hospital and Health Service, Nambour General Hospital, Nambour, Queensland, Australia
| | - Clare Thomas
- Department of Paediatrics, Sunshine Coast Hospital and Health Service, Nambour General Hospital, Nambour, Queensland, Australia
| | - Laxmi Camadoo
- Department of Paediatrics, Sunshine Coast Hospital and Health Service, Nambour General Hospital, Nambour, Queensland, Australia
| | - Erica Baer
- Department of Paediatrics, Sunshine Coast Hospital and Health Service, Nambour General Hospital, Nambour, Queensland, Australia
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17
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Zani A, Wolinska J, Cobellis G, Chiu PPL, Pierro A. Outcome of esophageal atresia/tracheoesophageal fistula in extremely low birth weight neonates (<1000 grams). Pediatr Surg Int 2016; 32:83-8. [PMID: 26519042 DOI: 10.1007/s00383-015-3816-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE To review the outcomes of extremely low birth weight (ELBW, <1000 g) infants with esophageal atresia/tracheoesophageal fistula (EA/TEF). METHODS Health records of ELBW EA/TEF infants treated at our institution from 2000 to 2014 were reviewed (REB1000046653). Demographics, operative approach and postoperative complications were analyzed. Data are reported as median (range). RESULTS Of 268 EA/TEF infants, 8 (3 %, five females) were ELBW (930 g, 540-995). Gestational age was 28 weeks (23-32). Seven had type-C EA/TEF and one type B. OUTCOMES One trisomy 18 infant received no treatment and died; one initially diagnosed as type A had primary repair at 126 days of life (DOL); six underwent TEF ligation (three trans-pleural) with primary repair in one and delayed anastomosis in two (DOL 120 and 178). The remaining three died (gastrostomy dehiscence and peritonitis, liver hemorrhage during peritoneal drain insertion, severe chronic lung disease and brain hemorrhages). At a median follow-up of 3 years (range 15 months-5 years), all survivors are thriving. CONCLUSION ELBW infants with EA/TEF are rare and result in high morbidity and mortality. Mortality is mainly related to complications not associated with EA/TEF repair. Fistula ligation followed by delayed anastomosis seems to achieve a better outcome in ELBW infants.
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Affiliation(s)
- Augusto Zani
- Division of General and Thoracic Surgery, Physiology and Experimental Medicine Program, The Hospital for Sick Children, University of Toronto, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Justyna Wolinska
- Division of General and Thoracic Surgery, Physiology and Experimental Medicine Program, The Hospital for Sick Children, University of Toronto, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Giovanni Cobellis
- Division of General and Thoracic Surgery, Physiology and Experimental Medicine Program, The Hospital for Sick Children, University of Toronto, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Priscilla P L Chiu
- Division of General and Thoracic Surgery, Physiology and Experimental Medicine Program, The Hospital for Sick Children, University of Toronto, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Agostino Pierro
- Division of General and Thoracic Surgery, Physiology and Experimental Medicine Program, The Hospital for Sick Children, University of Toronto, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada.
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Frazier JA, Wood ME, Ware J, Joseph RM, Kuban KC, O'Shea M, Allred EN, Leviton A. Antecedents of the child behavior checklist-dysregulation profile in children born extremely preterm. J Am Acad Child Adolesc Psychiatry 2015; 54:816-23. [PMID: 26407491 PMCID: PMC4615708 DOI: 10.1016/j.jaac.2015.07.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 07/25/2015] [Accepted: 07/29/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Extremely preterm newborns are at heightened risk for emotional and behavioral dysregulation later in childhood. Our goal was to systematically evaluate the antenatal and early postnatal antecedents that might mediate the association between extreme preterm birth and emotional and behavioral dysregulation at age 2 years (corrected age). METHOD In a multi-site prospective study, the parents of 826 infants born before 28 weeks gestation completed a Child Behavior Checklist (CBCL) when the child was 2 years corrected age. We compared the maternal, pregnancy, placenta, delivery, and newborn characteristics, as well as early postnatal characteristics and exposures of those who satisfied criteria for the CBCL-Dysregulation Profile (CBCL-DP) to those of their peers. We then used time-oriented logistic regression models, starting first with antenatal variables that distinguished children with the CBCL-DP profile from their peers, and then added the distinguishing postnatal variables. RESULTS Approximately 9% of the children had a CBCL-DP. In the time-oriented logistic regression model with antenatal variables only, low maternal education achievement, passive smoking, and recovery of Mycoplasma from the placenta were associated with increased risk, whereas histologic chorioamnionitis was associated with reduced risk. None of the postnatal variables added statistically significant discriminating information. CONCLUSION Very preterm newborns who later manifest the CBCL-DP at age 2 years differ in multiple ways from their preterm peers who do not develop the CBCL-DP, raising the possibility that potentially modifiable antenatal and early postnatal phenomena contribute to the risk of developing emotional and behavioral dysregulation.
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Affiliation(s)
- Jean A Frazier
- University of Massachusetts Memorial Health Care/University of Massachusetts Medical School, Worcester, MA.
| | - Mollie E Wood
- University of Massachusetts Memorial Health Care/University of Massachusetts Medical School, Worcester, MA
| | - Janice Ware
- Boston Children's Hospital/Harvard Medical School, Boston, MA
| | - Robert M Joseph
- Boston Medical Center/Boston University School of Medicine, Boston, MA
| | - Karl C Kuban
- Boston Medical Center/Boston University School of Medicine, Boston, MA
| | | | | | - Alan Leviton
- Boston Children's Hospital/Harvard Medical School, Boston, MA
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Outcomes of neonates with birth weight⩽500 g: a 20-year experience. J Perinatol 2015; 35:768-72. [PMID: 25950920 DOI: 10.1038/jp.2015.44] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/20/2015] [Accepted: 02/23/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Ethical dilemmas continue regarding resuscitation versus comfort care in extremely preterm infants. Counseling parents and making decisions regarding the care of these neonates should be based on reliable, unbiased and representative data drawn from geographically defined populations. We reviewed survival and morbidity data for our population at the edge of viability. STUDY DESIGN A retrospective review of our perinatal database was carried out to identify all infants born alive and admitted to the neonatal intensive care unit (NICU) with BW⩽500 g between 1989 and 2009. Data from the initial hospital stay and follow-up at 24 months were collected. RESULT Out of 22 672 NICU admissions, 273 were eligible: 212 neonates were reviewed after excluding infants with comfort care. BW ranged from 285 to 500 g (mean 448 g) and gestational age range 22 to 28 weeks (median 24 week). Sixty-one (28.8%) survived until discharge. Only 13.8% males survived compared with 39.2% females (P<0.05). Half (49%) were discharged with home oxygen/monitor. Fifty (82%) patients' charts were available to review at the 24-month follow-up. Thirty-three percent of surviving infants had a normal neurodevelopmental assessment at 24 months. Forty-three percent had weight/head circumference<5th percentile at 24 months. CONCLUSION About a third of neonates admitted to NICU with ⩽500 g BW survived, with 33% of those surviving, demonstrating age-appropriate development at a 24-month follow-up visit.
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Van Lieshout RJ, Boyle MH, Schmidt LA, Saigal S, Ferro MA. Measurement Invariance Across Parent and Self-Ratings of Extremely Low Birth Weight Survivors and Normal Birth Weight Controls in Childhood and Adolescence on the Child Behavior Checklist and Youth Self-Report. J Pediatr Psychol 2015; 40:825-33. [PMID: 25981895 DOI: 10.1093/jpepsy/jsv043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 04/20/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study examined the measurement invariance of the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) DSM-oriented scales between extremely low birth weight (ELBW) and normal birth weight (NBW) youth. METHODS The sample included 158 ELBW survivors and 145 matched, NBW controls at 8 and 12-16 years of age. RESULTS Strict invariance was established at 8 years for parent-reported CBCL attention-deficit hyperactivity, conduct, and oppositional defiant scales, though invariance could not be established for affective problems at 8 or 12-16 years. Strict invariance was observed between 12-16-year-old ELBW and NBW groups on attention-deficit hyperactivity, anxiety, and oppositional defiant CBCL and YSR scales. Invariance could not be established for youth-reported conduct problems. CONCLUSIONS While the majority of CBCL/YSR DSM-oriented subscales assess the same concepts in both ELBW and NBW children and adolescents across parent and youth reports, this may not be the case for affective and conduct problems.
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Affiliation(s)
| | | | | | | | - Mark A Ferro
- Department of Psychiatry and Behavioural Neurosciences, Department of Pediatrics, McMaster University
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Waxman JA, Lieshout RJ, Boyle MH, Saigal S, Schmidt LA. Linking extremely low birth weight and internalizing behaviors in adult survivors: Influences of neuroendocrine dysregulation. Dev Psychobiol 2015; 57:486-96. [DOI: 10.1002/dev.21308] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 03/01/2015] [Accepted: 03/11/2015] [Indexed: 01/29/2023]
Affiliation(s)
- Jordana A. Waxman
- Department of Psychology; York University; Toronto Ontario Canada
- Department of Psychology; Neuroscience and Behaviour; McMaster University; Hamilton Ontario Canada
| | - Ryan J.Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences; McMaster University; Hamilton Ontario Canada
| | - Michael H. Boyle
- Department of Psychiatry and Behavioural Neurosciences; McMaster University; Hamilton Ontario Canada
| | - Saroj Saigal
- Department of Pediatrics; McMaster University; Hamilton Ontario Canada
| | - Louis A. Schmidt
- Department of Psychology; Neuroscience and Behaviour; McMaster University; Hamilton Ontario Canada
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Van Lieshout RJ, Boyle MH, Saigal S, Morrison K, Schmidt LA. Mental health of extremely low birth weight survivors in their 30s. Pediatrics 2015; 135:452-9. [PMID: 25667243 DOI: 10.1542/peds.2014-3143] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine the risk for psychiatric disorders among extremely low birth weight (ELBW) survivors in their early to mid-30s and to determine whether those born small for gestational age or those exposed to a full course of antenatal corticosteroids (ACS) were at particularly high risk. METHODS A prospective, longitudinal, population-based cohort of 84 ELBW survivors and 90 normal birth weight (NBW) control participants born in Ontario, Canada from 1977 to 1982 were assessed by interviewers naive to birth weight status using the Mini-International Neuropsychiatric Interview. RESULTS ELBW survivors had lower odds of an alcohol or substance use disorder but higher odds of current non-substance-related psychiatric problems (odds ratio [OR] = 2.47; 95% confidence interval [CI], 1.19-5.14). Those born ELBW and SGA exhibited the same patterns with larger effects. ACS-exposed ELBW survivors had even higher odds of any current non-substance-related psychiatric disorder (OR = 4.41; 95% CI, 1.65-11.82), particularly generalized anxiety disorder (OR = 3.42; 95% CI, 1.06-11.06), the generalized type of social phobia (OR = 5.80; 95% CI, 1.20-27.99), and the inattentive subtype of attention-deficit/hyperactivity disorder (OR = 11.45; 95% CI, 2.06-63.50). CONCLUSIONS In their early to mid-30s, ELBW survivors were less likely to have alcohol or substance use disorders but may be at greater risk for other psychiatric problems. Those exposed to ACS were at especially high risk and manifested no reduction in alcohol or substance use disorders. ELBW survivors exposed to ACS may be a special group at risk for psychopathology in adulthood.
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Affiliation(s)
| | | | | | | | - Louis A Schmidt
- Psychology, Neuroscience, & Behaviour, McMaster University, Hamilton, Ontario, Canada
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Niedermaier S, Hilgendorff A. Bronchopulmonary dysplasia - an overview about pathophysiologic concepts. Mol Cell Pediatr 2015; 2:2. [PMID: 26542292 PMCID: PMC4530566 DOI: 10.1186/s40348-015-0013-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 01/25/2015] [Indexed: 12/27/2022] Open
Abstract
Neonatal chronic lung disease in the preterm infant, i.e. bronchopulmonary dysplasia (BPD) is characterized by impaired pulmonary development with its effects persisting into adulthood. Triggered in the immature lung by infectious complications, oxygen toxicity and the impact of mechanical ventilation, a sustained inflammatory response, extensive remodeling of the extracellular matrix, increased apoptosis as well as altered growth factor signaling characterize the disease. The current review focuses on selected pathophysiologic processes and their interplay in disease development. Furthermore, the potential of both, acute and long-term changes to the pulmonary scaffold and the cellular interface in concert with dysregulated growth factor signaling to affect aging and repair processes in the adult lung is discussed.
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Affiliation(s)
- Sophie Niedermaier
- Comprehensive Pneumology Center (CPC), Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich Max-Lebsche-Platz 31, 81377, Munich, Germany. .,Dr. von Hauner Children's Hospital, Ludwig-Maximilians University Munich, Munich, Germany.
| | - Anne Hilgendorff
- Comprehensive Pneumology Center (CPC), Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich Max-Lebsche-Platz 31, 81377, Munich, Germany. .,Dr. von Hauner Children's Hospital, Ludwig-Maximilians University Munich, Munich, Germany.
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Hilgendorff A, O'Reilly MA. Bronchopulmonary dysplasia early changes leading to long-term consequences. Front Med (Lausanne) 2015; 2:2. [PMID: 25729750 PMCID: PMC4325927 DOI: 10.3389/fmed.2015.00002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 01/05/2015] [Indexed: 12/05/2022] Open
Abstract
Neonatal chronic lung disease, i.e., bronchopulmonary dysplasia, is characterized by impaired pulmonary development resulting from the impact of different risk factors including infections, hyperoxia, and mechanical ventilation on the immature lung. Remodeling of the extracellular matrix, apoptosis as well as altered growth factor signaling characterize the disease. The immediate consequences of these early insults have been studied in different animal models supported by results from in vitro approaches leading to the successful application of some findings to the clinical setting in the past. Nonetheless, existing information about long-term consequences of the identified early and most likely sustained changes to the developing lung is limited. Interesting results point towards a tremendous impact of these early injuries on the pulmonary repair capacity as well as aging related processes in the adult lung.
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Affiliation(s)
- Anne Hilgendorff
- Comprehensive Pneumology Center, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL) , Munich , Germany ; Neonatology, Perinatal Center Grosshadern, Dr. von Hauner Children's Hospital, Ludwig-Maximilians University , Munich , Germany
| | - Michael A O'Reilly
- Department of Pediatrics, School of Medicine and Dentistry, The University of Rochester , Rochester, NY , USA
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Legrand F, Boulkedid R, Elie V, Leroux S, Valls E, Valls-i-Soler A, Van den Anker JN, Jacqz-Aigrain E. A Delphi process to optimize quality and performance of drug evaluation in neonates. PLoS One 2014; 9:e104976. [PMID: 25210742 PMCID: PMC4161344 DOI: 10.1371/journal.pone.0104976] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 05/16/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Neonatal trials remain difficult to conduct for several reasons: in particular the need for study sites to have an existing infrastructure in place, with trained investigators and validated quality procedures to ensure good clinical, laboratory practices and a respect for high ethical standards. The objective of this work was to identify the major criteria considered necessary for selecting neonatal intensive care units that are able to perform drug evaluations competently. METHODOLOGY AND MAIN FINDINGS This Delphi process was conducted with an international multidisciplinary panel of 25 experts from 13 countries, selected to be part of two committees (a scientific committee and an expert committee), in order to validate criteria required to perform drug evaluation in neonates. Eighty six items were initially selected and classified under 7 headings: "NICUs description-Level of care" (21), "Ability to perform drug trials: NICU organization and processes (15), "Research Experience" (12), "Scientific competencies and area of expertise" (8), "Quality Management" (16), "Training and educational capacity" (8) and "Public involvement" (6). Sixty-one items were retained and headings were rearranged after the first round, 34 were selected after the second round. A third round was required to validate 13 additional items. The final set includes 47 items divided under 5 headings. CONCLUSION A set of 47 relevant criteria will help to NICUs that want to implement, conduct or participate in drug trials within a neonatal network identify important issues to be aware of. SUMMARY POINTS 1) Neonatal trials remain difficult to conduct for several reasons: in particular the need for study sites to have an existing infrastructure in place, with trained investigators and validated quality procedures to ensure good clinical, laboratory practices and a respect for high ethical standards. 2) The present Delphi study was conducted with an international multidisciplinary panel of 25 experts from 13 countries and aims to identify the major criteria considered necessary for selecting neonatal intensive care units (NICUs) that are able to perform drug evaluations competently. 3) Of the 86 items initially selected and classified under 7 headings--"NICUs description-Level of care" (21), "Ability to perform drug trials: NICU organization and processes (15), "Research Experience" (12), "Scientific competencies and area of expertise" (8), "Quality Management" (16), "Training and educational capacity" (8) and "Public involvement" (6)--47 items were selected following a three rounds Delphi process. 4) The present consensus will help NICUs to implement, conduct or participate in drug trials within a neonatal network.
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Affiliation(s)
- Frederic Legrand
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Paediatric Pharmacology and Pharmacogenetics, Inserm CIC 9202 (Centre d'Investigation Clinique pédiatrique), University Diderot Paris VII, Hôpital Robert Debré, Paris, France
| | - Rym Boulkedid
- AP-HP (Assistance Publique des Hôpitaux de Paris), Unité de Recherche Clinique (URC), Inserm CIE5 (Centre d'Investigation clinique Epidémiologie clinique), Hôpital Robert Debré, Paris, France
| | - Valery Elie
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Paediatric Pharmacology and Pharmacogenetics, Inserm CIC 9202 (Centre d'Investigation Clinique pédiatrique), University Diderot Paris VII, Hôpital Robert Debré, Paris, France
| | - Stephanie Leroux
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Paediatric Pharmacology and Pharmacogenetics, Inserm CIC 9202 (Centre d'Investigation Clinique pédiatrique), University Diderot Paris VII, Hôpital Robert Debré, Paris, France
| | - Elizabeth Valls
- University of Basque country, Head Neonatal Intensive care Unit, Cruces University Hospital, Barakaldo-Bilbao, Spain
| | - Adolfo Valls-i-Soler
- University of Basque country, Head Neonatal Intensive care Unit, Cruces University Hospital, Barakaldo-Bilbao, Spain
| | - Johannes N. Van den Anker
- Evan and Cindy Jones Professor of Paediatric Clinical Pharmacology Chief, Division of Clinical Pharmacology, Children's National Health System, Washington, District of Columbia, United States of America
| | - Evelyne Jacqz-Aigrain
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Paediatric Pharmacology and Pharmacogenetics, Inserm CIC 9202 (Centre d'Investigation Clinique pédiatrique), University Diderot Paris VII, Hôpital Robert Debré, Paris, France
- * E-mail:
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Abstract
This review is presented in three segments: (1) important background concepts, (2) recent reports from regional geographically defined cohorts, and (3) prognosis research from the National Institutes of Health Neonatal Research Network. Extending the use of intensive care to newborns of lower gestational ages will unavoidably result in a higher proportion and a higher absolute number of survivors with morbidity, unless other changes in practice offset the increased risk associated with decreasing gestational age. In geographically defined cohort studies, the proportion of periviable newborns delivered in perinatal centers and the practices around foregoing and withdrawing intensive care are two important determinants of outcomes following periviable birth. It is much easier to quantify the effect of the former than the latter. Decisions regarding comfort care vs. intensive are frequently based on gestational age as the sole predictor variable, although multiple factors can be readily used to more accurately assess the benefits and burdens of intensive care and facilitate better informed parental counseling and decision making.
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Affiliation(s)
- Cody Arnold
- Department of Pediatrics, University of Texas Health Science Center at Houston Medical School, 6431 Fannin, St, MSB 3.242, Houston, TX 77030.
| | - Jon E Tyson
- Center for Clinical Research & Evidence-Based Medicine, University of Texas Health Science Center at Houston Medical School, Houston, TX
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Waxman J, Van Lieshout RJ, Saigal S, Boyle MH, Schmidt LA. Still cautious: Personality characteristics of extremely low birth weight adults in their early 30s. PERSONALITY AND INDIVIDUAL DIFFERENCES 2013. [DOI: 10.1016/j.paid.2013.08.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Barbier A, Boivin A, Yoon W, Vallerand D, Platt RW, Audibert F, Barrington KJ, Shah PS, Nuyt AM. New reference curves for head circumference at birth, by gestational age. Pediatrics 2013; 131:e1158-67. [PMID: 23509164 DOI: 10.1542/peds.2011-3846] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The measurement of head circumference (HC) at birth reflects intrauterine brain development. HC charts currently used in Canada are either dated, mixed-gender, nonrepresentative of lower gestational ages (GAs), or reflective of other populations. METHODS To create both birth weight and HC curves, we combined weight and HC data from the Canadian Neonatal Network (CNN) database (admissions in NICUs across Canada) with McGill's Obstetrical Neonatal Database (MOND; all births at a tertiary hospital in Montreal, Canada). We included CNN data for GAs of 23 to 34 weeks (2003-2007) and MOND data for GAs of 35 to 41 weeks (1995-2006). Nonsingletons, congenital anomalies, and measurements greater than ±4 SD from the mean were excluded. Distributions of birth weight and HC at each GA were statistically (penalized spline regression) smoothed. Birth weight curves were compared with recent Canadian reference curves and HC curves with historical and/or frequently used curves. RESULTS We included 39,896 births (3121 births at <30 weeks' GA) to generate the curves. Current weight curves were similar to Canadian reference charts for both genders. Weight and HC measurements in boys were higher than in girls. When classified according to recent international references, the proportion of CNN-MOND infants at ≥32 weeks' GA with HCs <10th percentile was significantly underestimated. When classified according to historical reference curves, a significant number of CNN-MOND infants of all GAs with HCs <10th and >90th percentiles were misclassified. CONCLUSIONS We developed recent gender-specific reference curves for HC at birth for singletons at 23 to 41 completed weeks' GA, which included a large number of very premature infants, reflecting the current geotemporal Canadian population.
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Affiliation(s)
- Alexandre Barbier
- Departments of aPediatrics (Neonatology), Sainte-Justine University Hospital and Research Centre, University of Montreal, Quebec, Canada
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Shim JW, Kim MJ, Kim EK, Park HK, Song ES, Lee SM, Lee JH, Jin HS, Kim ES, Chang YS. The impact of neonatal care resources on regional variation in neonatal mortality among very low birthweight infants in Korea. Paediatr Perinat Epidemiol 2013; 27:216-25. [PMID: 23374067 DOI: 10.1111/ppe.12033] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Faced with extremely low fertility rates and increasing numbers of low-birthweight births in Korea, we examined the factors affecting the mortality of very-low-birthweight (VLBW) infants in Korea. METHODS A survey was conducted in 91 of 93 hospitals providing neonatal intensive care in Korea in 2009. Data included information on number of neonatal intensive care unit (NICU) beds, medical workforce, resources in the NICU, birth and death. RESULTS There was approximately one NICU per 4888 births, one NICU bed per 355 births, one mechanical ventilator per 739 births, one incubator per 327 births and one board-certified neonatologist per 4683 births. Regional disparity existed in neonatal care resources and consequently in mortality rates. VLBW infants' mortality was related to the NICU facility level, volume of VLBW infants and geographic regions. The capital city, Seoul, has the best NICU facilities and workforce, and the least mortality. Overall mortality rates before hospital discharge for <750, 750-999 and 1000-1499 g were 44.8%, 20.4% and 6.5% respectively. There was a two to threefold difference in the mortality rates across the regions. However, following adjustments for NICU facility level and volume of VLBW infants admissions, regional difference in mortality rates was markedly reduced in the <750 g and disappeared in the larger VLBW groups. CONCLUSIONS Regional disparity in mortality of VLBW infants in Korea is most marked in the lowest-birthweight group, <750 g. This disparity is primarily due to lack of resources for neonatal intensive care in most of provincial areas.
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Affiliation(s)
- Jae Won Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Andrews B, Lagatta J, Chu A, Plesha-Troyke S, Schreiber M, Lantos J, Meadow W. The nonimpact of gestational age on neurodevelopmental outcome for ventilated survivors born at 23-28 weeks of gestation. Acta Paediatr 2012; 101:574-8. [PMID: 22277021 DOI: 10.1111/j.1651-2227.2012.02609.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM It has long been known that survival of preterm infants strongly depends upon birth weight and gestational age. This study addresses a different question - whether the gestational maturity improves neurodevelopmental outcomes for ventilated infants born at 23-28 weeks who survive to neonatal intensive care unit (NICU) discharge. METHODS We performed a prospective cohort study of 199 ventilated infants born between 23 and 28 weeks of gestation. Neurodevelopmental impairment was determined using the Bayley Scales of Infant Development-II at 24 months. RESULTS As expected, when considered as a ratio of all births, both survival and survival without neurodevelopmental impairment were strongly dependent on gestational age. However, the percentage of surviving infants who displayed neurodevelopmental impairment did not vary with gestational age for any level of neurodevelopmental impairment (MDI or PDI <50, <60, <70). Moreover, as a higher percentage of ventilated infants survived to NICU discharge at higher gestational ages, but the percentage of neurodevelopmental impairment in NICU survivors was unaffected by gestational age, the percentage of all ventilated births who survived with neurodevelopmental impairment rose - not fell - with increasing gestation age. CONCLUSION For physicians, parents and policy-makers whose primary concern is the presence of neurodevelopmental impairment in infants who survive the NICU, reliance on gestational age appears to be misplaced.
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Affiliation(s)
- Bree Andrews
- Department of Pediatrics, The University of Chicago, IL 60637, USA
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Pantou K, Drougia A, Krallis N, Hotoura E, Papassava M, Andronikou S. Perinatal and neonatal mortality in Northwest Greece (1996-2004). J Matern Fetal Neonatal Med 2011; 23:1237-43. [PMID: 20082595 DOI: 10.3109/14767050903544769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE An improvement in perinatal mortality is reported in various countries. This is a retrospective analysis of perinatal and neonatal mortality in Northwest (NW) Greece. METHODS Analysis was made of the births and deaths register in NW Greece and records of the regional referral tertiary care center and the National Hospitals at the same area for the period 1996-2004. Perinatal mortality was analysed according to birthweight (BW) and gestational age (GA) for two separate periods, 1996-1999 (I) and 2000-2004 (II), corresponding to an increase in antenatal steroid use from 20% to 63%. RESULTS Neonatal mortality improved between the two periods in infants with very low BW [very low birth weight (VLBW), <1500 g] and the very preterm infants (<28 weeks GA). Severe respiratory distress syndrome (RDS) decreased (p<0.001) for infants with GA≤34 weeks and those with BW 751-1500 g (p<0.02), and perinatal asphyxia is no longer a leading cause of death. Intrauterine transfer increased (p<0.001) for infants with BW≤1500 g. The main cause of death as derived from birth records and neonatal intensive care unit records is prematurity, alone or with complications. CONCLUSIONS With the introduction of antenatal steroids and increase in intrauterine transfer there has been a decrease in neonatal mortality of VLBW infants in NW Greece.
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Affiliation(s)
- K Pantou
- Neonatal Intensive Care Unit, Department of Child Health, School of Medicine, University of Ioannina, Ioannina, Greece
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Long-term morbidities associated with vocal cord paralysis after surgical closure of a patent ductus arteriosus in extremely low birth weight infants. J Perinatol 2010; 30:408-13. [PMID: 19759545 PMCID: PMC2878380 DOI: 10.1038/jp.2009.124] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Determine associations between left vocal cord paralysis (LVCP) and poor respiratory, feeding and/or developmental outcomes in extremely low birth weight (ELBW) infants following surgical closure of a patent ductus arteriosus (PDA). STUDY DESIGN ELBW infants who underwent PDA ligation between January 2004 and December 2006 were identified. We compared infants with and without LVCP following ligation to determine relationships between LVCP and respiratory morbidities, feeding and growth difficulties and neurodevelopmental impairment at 18 to 22-month follow-up. Student's t-test, Fisher's exact test and multivariable regression analyses were used to determine associations. RESULT In all, 60 ELBW infants with a mean gestational age of 25 weeks and mean birth weight of 725 g had a PDA surgically closed. Twenty-two of 55 survivors (40%) were diagnosed with LVCP post-operatively. Infants with LVCP were significantly more likely to develop bronchopulmonary dysplasia (82 vs 39%, P=0.002), reactive airway disease (86 vs 33%, P<0.0001), or need for gastrostomy tube (63 vs 6%, P<0.0001). CONCLUSION LVCP as a complication of surgical ductal ligation in ELBW infants is associated with persistent respiratory and feeding problems. Direct laryngoscopy should be considered for all infants who experience persistent respiratory and/or feeding difficulties following PDA ligation.
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De Nisi G, Berti M, Malossi R, Pederzini F, Pedrotti A, Valente A. Comparison of neonatal intensive care: Trento area versus Vermont Oxford Network. Ital J Pediatr 2009; 35:5. [PMID: 19490662 PMCID: PMC2687545 DOI: 10.1186/1824-7288-35-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Accepted: 03/14/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND S. Chiara hospital is the only neonatal intensive care unit (NICU) in the Province of Trento (Italy). It serves a population of about 460000 people with about 5000 infants per year, admitting the totality of the inborn and outborn VLBWI of the province. The aim of this work is to compare mortality, morbidity and neonatal treatment of the very low birth weight infants (VLBWI) of Trento area with those recorded in the Vermont Oxford Network (VON) during 2004. METHODS In this retrospective analysis, the rates of complications and related treatments reported in VLBWI admitted in the S. Chiara NICU during the period 2000-2005 were compared with those recorded in the VON in 2004. The analysis included both the total populations and different weight groups. RESULTS The frequency of inborn infants was significantly higher in Trento than in VON: 91% vs 84% (MH 8.56; p-value 0.003). The administration of prenatal steroids (82% vs 74%; MH 7.47 and p-value 0.006) and caesarean section were significantly more frequent in the Trento area than in VON. In Trento significantly more VLBWI with BW = 1000 grams were given surfactant prophylaxis compared with VON and significantly fewer VLBWI in every Trento weight group developed RDS (MH 18.55; p-value 0.00001). Overall rates of complications (CLD, PDA, NEC, IVH) were significantly lower than in the Vermont Oxford Network. In CLD and PDA the differences were marked also in infants weighting less than 1000 grams. Overall rates of PNX, PVL, severe grade of ROP and mortality were similar in the two populations. In Trento, significantly more infants were discharged on human milk than in VON, in both the overall population and in BW sub-groups. CONCLUSION On the basis of this analysis, a less aggressive therapeutic strategy based on perinatal prevention in global management, such as that employed in Trento area, may be associated with an improvement in clinical outcomes in very low birth weight infants.
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Affiliation(s)
- Giuseppe De Nisi
- Neonatology and neonatal intensive care, S. Chiara Hospital, Trento, Italy
| | - Mariarosaria Berti
- Neonatology and neonatal intensive care, S. Chiara Hospital, Trento, Italy
| | - Riccardo Malossi
- Neonatology and neonatal intensive care, S. Chiara Hospital, Trento, Italy
| | - Fabio Pederzini
- Neonatology and neonatal intensive care, S. Chiara Hospital, Trento, Italy
| | - Anna Pedrotti
- Neonatology and neonatal intensive care, S. Chiara Hospital, Trento, Italy
| | - Alberta Valente
- Neonatology and neonatal intensive care, S. Chiara Hospital, Trento, Italy
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Itabashi K, Horiuchi T, Kusuda S, Kabe K, Itani Y, Nakamura T, Fujimura M, Matsuo M. Mortality rates for extremely low birth weight infants born in Japan in 2005. Pediatrics 2009; 123:445-50. [PMID: 19171608 DOI: 10.1542/peds.2008-0763] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Our goal was to investigate the neonatal mortality rate and the mortality rate during the NICU stay for extremely low birth weight infants born in Japan in 2005. METHODS The Committee of Neonatal Medicine of the Japan Pediatric Society retrospectively surveyed the deaths of extremely low birth weight infants born and hospitalized between January 1 and December 31, 2005. From 297 institutions in Japan, data on 3065 extremely low birth weight infants, which represented 98.4% of those reported in the maternal and health statistics of Japan in 2005, were collected. RESULTS The neonatal mortality rate and the mortality rate during the NICU stay were 13.0% and 17.0%, respectively, which were lower than 17.7% and 21.5% in the survey in 2000. The neonatal mortality rates and the mortality rates during the NICU stay were 53.3% and 67.7% in the <400-g birth weight group (n = 62), 42.1% and 53.5% in the 400- to 499-g birth weight group (n = 159), 22.2% and 27.7% in the 500- to 599-g birth weight group (n = 387), 16.8% and 22.2% in the 600- to 699-g birth weight group (n = 537), 9.4% and 12.7% in the 700- to 799-g birth weight group (n = 574), 6.3% and 9.1% in the 800- to 899-g birth weight group (n = 649), and 3.9% and 5.3% in the 900- to 999-g birth weight group (n = 697), respectively. The factors involved in the deaths of extremely low birth weight infants included lower gestational age, lower birth weight, male gender, multiple birth, institutions in which <10 extremely low birth weight infants were admitted per year, and no prenatal maternal transfer. CONCLUSION The mortality rates of extremely low birth weight infants who were born in 2005 demonstrated definite improvement.
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Affiliation(s)
- Kazuo Itabashi
- Department of Pediatrics, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan.
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Cautionary tales from the neonatal intensive care unit: diapers may mislead urinary output estimation in extremely low birthweight infants. Pediatr Crit Care Med 2008; 9:76-9. [PMID: 18477917 DOI: 10.1097/01.pcc.0000298550.29453.7d] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the validity of the weighing of modern polyacrylate diapers to determine urine output in the extremely low birth weight infant nursed in a humidified incubator. DESIGN Observational study with repeated measures using high-absorbency cellulose/polyacrylate diapers and a humidified incubator in a modeled clinical scenario. SETTING A tertiary referral neonatal intensive care unit. INTERVENTIONS Six dry diapers were placed into eight levels of humidity, between 55% and 90% inclusive, in an incubator set at 37 degrees C. Hourly weight increments were recorded. The study was repeated with 5 mL of normal saline added to the diaper to mimic prior urine output. Results were compared by Kruskal-Wallis nonparametric analysis of variance. MEASUREMENTS AND MAIN RESULTS Dry diapers increased in weight for each humidity level after 1 hr (p < .05). This was significantly greater at higher humidity. The maximum increase was a median of 3.06 g (range, 2.47-3.31 g) at 85% humidity after 6 hrs. When 5 mL of 0.9% saline had been added, the diaper weight changes depended on environmental relative humidity. At > or = 80% humidity, the diapers continued to gain weight; at 70% or 75% humidity, they did not change weight; and at < or = 65% humidity, the diapers lost weight. Maximal evaporative loss was median 1.11 g (range, 0.8-1.24 g) at 6 hrs in 55% relative humidity. CONCLUSIONS The use of diaper weighing in high-humidity infant environments may not be an accurate measure of actual urine output in the extremely low birth weight infant. This study demonstrates the need for caution when interpreting this measure, and we discuss some possible clinical approaches to ameliorate this difficulty.
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Abstract
Neonatal survival continues to improve; for many years, including throughout the 1990s there have been anxieties that this was at the cost of additional morbidity, most particularly in terms of neurosensory impairments. Recent evidence suggests that rates of neuromotor morbidity, in particular cerebral palsy, may be declining for all but the most immature babies. Severe sensory impairment has a low, but relatively static incidence. High prevalence, low severity motor problems and their inter-relationship with developmental co-ordination disorder, executive dysfunction and cognitive impairment are increasingly recognised and correlated with reduced school performance. Because of difficulties in comparing outcomes across different populations, validated motor and manual function classifications have been developed for children with cerebral palsy and can help to standardise outcome measures. Improved neuro-imaging is helping us understand the types and consequences of neonatal brain injury. The possibility of using composite measures of early motor movement quality, longitudinal use of motor classification systems and volumetric magnetic resonance imaging (MRI) imaging to understand developmental processes needs to be explored.
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Affiliation(s)
- Joe Fawke
- School of Human Development, University of Nottingham, Nottingham, UK.
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37
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Msall ME. The panorama of cerebral palsy after very and extremely preterm birth: evidence and challenges. Clin Perinatol 2006; 33:269-84. [PMID: 16765724 DOI: 10.1016/j.clp.2006.03.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
During the past 2 decades, major advances in maternal-fetal medicine and neonatology have resulted in unprecedented survival of very preterm (<32 weeks) and extremely preterm (<28 weeks) babies. Despites these advances in prenatal care, neurodevelopmental motor impairment remains a substantial sequela. This article describes the major progress and challenges in understanding pathways of preterm children who go on to have one of the cerebral palsy syndromes. The contributions of chronic lung disease, intraventricular hemorrhage, retinopathy of prematurity, and postnatal steroids are analyzed. Management can then be directed to limiting the comorbidities that are associated with threats to survival and to improving protection of central nervous system functions that are involved in moving, manipulative skills, feeding, communication, and learning.
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Affiliation(s)
- Michael E Msall
- University of Chicago, Pritzker School of Medicine, Kennedy Mental Retardation Center, Comer Children's and LaRabida Children's Hospitals, IL 60637, USA.
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38
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Doyle LW. The burden of illness in perinatal and neonatal care: the epidemiologist's role. Semin Fetal Neonatal Med 2006; 11:69-72. [PMID: 16483860 DOI: 10.1016/j.siny.2005.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Clinical research to improve outcomes of pregnancy and perinatal/neonatal care and to reduce the burden of illness is grounded in modern principles of evidence-based clinical practice. The central tool for creating convincing evidence is the randomised controlled trial (RCT). However, creating evidence is only one step to the overall goal of reducing the burden of illness. Once new evidence has been created by a RCT it must be synthesised with existing evidence, the evidence must be applied and disseminated into clinical practice, and the effect of the new evidence on the specific illness being targeted must be re-evaluated. Perinatal/neonatal epidemiologists require multiple skills to understand not only how to evaluate the burden of illness and to identify problems that might have solutions, but also how to create and synthesise evidence, apply it in practice and evaluate its clinical application, even though they need not be equally expert in all areas.
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Affiliation(s)
- Lex W Doyle
- Department of Obstetrics & Gynaecology, The Royal Women's Hospital, 132 Grattan St, Carlton, Victoria 3053, and University of Melbourne, Melbourne, Australia.
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