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Nelin TD, Radack JK, Yang N, Lorch SA, DeMauro SB, Bamat NA, Jensen EA, Gibbs K, Murosko DC, Scott KA, Goldstein NPN, Just AC, Burris HH. Associations of PM 2.5 exposure with emergency department visits and readmissions among preterm infants with bronchopulmonary dysplasia. Pediatr Pulmonol 2024. [PMID: 38958238 DOI: 10.1002/ppul.27164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/07/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVES To quantify the association of ambient air pollution (particulate matter, PM2.5) exposure with medically attended acute respiratory illness among infants with bronchopulmonary dysplasia (BPD). STUDY DESIGN Single center, retrospective cohort study of preterm infants with BPD in Metropolitan Philadelphia. Multivariable logistic regression quantified associations of annual mean PM2.5 exposure (per μg/m3) at the census block group level with medically attended acute respiratory illness, defined as emergency department (ED) visits or hospital readmissions within a year after first hospital discharge adjusting for age at neonatal intensive care unit (NICU) discharge, year, sex, race, insurance, BPD severity, and census tract deprivation. As a secondary analysis, we examined whether BPD severity modified the associations. RESULTS Of the 378 infants included in the analysis, 189 were non-Hispanic Black and 235 were publicly insured. Census block PM2.5 level was not significantly associated with medically attended acute respiratory illnesses, ED visits, or hospital readmissions in the full study cohort. We observed significant effect modification by BPD grade; each 1 µg/m3 higher annual PM2.5 exposure was medically attended acute respiratory illness (adjusted odds ratio [aOR] 1.65, 95% CI: 1.06-2.63) among infants with Grade 1 BPD but not among infants with grade 3 BPD (aOR 0.83, 95% CI: 0.47-1.48) (interaction p = .024). CONCLUSIONS Cumulative PM2.5 exposure in the year after NICU discharge was not significantly associated with medically attended acute respiratory illness among infants with BPD. However, infants with Grade 1 BPD had significantly higher odds with higher exposures. If replicated, these findings could inform anticipatory guidance for families of these infants to avoid outdoor activities during high pollution days after NICU discharge.
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Affiliation(s)
- Timothy D Nelin
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Center of Excellence in Environmental Toxicology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, USA
| | - Joshua K Radack
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Nancy Yang
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Scott A Lorch
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, USA
| | - Sara B DeMauro
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Neonatal Follow-Up Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Nicolas A Bamat
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Newborn/Infant Chronic Lung Disease Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Erik A Jensen
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Newborn/Infant Chronic Lung Disease Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kathleen Gibbs
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Newborn/Infant Chronic Lung Disease Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Daria C Murosko
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, USA
| | - Kristan A Scott
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nicolas P Novick Goldstein
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Allan C Just
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Institute at Brown for Environment and Society, Brown University, Providence, Rhode Island, USA
| | - Heather H Burris
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Center of Excellence in Environmental Toxicology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, USA
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Callahan KP, Farrell K, Gibbs K, Kielt MJ, Morris H, Nilan K, Thomas S, DeMauro SB. Childhood outcomes following discharge from a referral bronchopulmonary dysplasia program. J Perinatol 2024:10.1038/s41372-024-02035-w. [PMID: 38937610 DOI: 10.1038/s41372-024-02035-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/13/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVES The primary objective of this study was to profile the childhood health, development, and health-related quality of life (HR QoL) for children with the most severe bronchopulmonary dysplasia (BPD), those discharged from a quaternary referral program. STUDY DESIGN We collected cross-sectional data through telephone interviews with 282 families of children ages 18 months to 11 years who had been discharged from a BPD referral program. RESULTS Respiratory morbidities were near universal, with 42% of children ever having required a tracheostomy and severity of these morbidities correlated with parent-reported health and QoL. Developmental morbidities were also marked: 97% required an individualized educational plan. While respiratory morbidities and overall health improved over time, developmental morbidities were increasingly prominent, resulting in lower quality of life. CONCLUSIONS Among children referred to a quaternary BPD program, respiratory and developmental morbidities are on numerous counts more severe than any reported in the literature.
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Affiliation(s)
- Katharine P Callahan
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Department of Medical Ethics and Health Policy, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Kathryn Farrell
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Kathleen Gibbs
- Department of Medical Ethics and Health Policy, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Heidi Morris
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kathleen Nilan
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Sara B DeMauro
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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3
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Bathgate JR, Pike K, Newkirk M, Rigassio Radler DL, Byham-Gray L, Ziegler J. Development of a bronchopulmonary dysplasia nutrition focused physical examination tool: A modified Delphi study. Pediatr Pulmonol 2024; 59:1695-1707. [PMID: 38558410 DOI: 10.1002/ppul.26976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/02/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The objectives of this study were to identify factors impacting nutrition needs in infants and children with bronchopulmonary dysplasia (BPD). A modified Delphi approach to obtain consensus among pediatric registered dietitian nutritionists (RDNs) was used to create a BPD-specific nutrition focused physical examination (NFPE) tool. STUDY DESIGN RDNs, recruited through pediatric nutrition professional associations, completed a survey rating proposed NFPE components on a Likert scale of 1-5 allowing open-ended responses in a two-round Delphi. Responses were analyzed, deidentified, and results were returned to panelists for in-round feedback. Consensus was defined a priori as 75% agreement for usefulness or relevance ± 1 standard deviation. RESULTS Six domains (anthropometrics, body composition, development, gastrointestinal, respiratory, and physical signs) and 38 components achieved consensus. CONCLUSION Components for an evidence-based tool to enhance nutrition assessment in infants and children with BPD were identified with consensus agreement by an expert panel of 19 pediatric RDNs.
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Affiliation(s)
| | | | | | | | | | - Jane Ziegler
- Rutgers University, New Brunswick, New Jersey, USA
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Szeto JJ, Radack JK, DeMauro SB, Jensen EA, Gibbs K, Novick NP, Scott KA, Murosko DC, Burris HH, Nelin TD. Environmental Determinants of Post-Discharge Acute Respiratory Illness among Preterm Infants with Bronchopulmonary Dysplasia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:648. [PMID: 38791862 PMCID: PMC11120865 DOI: 10.3390/ijerph21050648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/17/2024] [Accepted: 05/18/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE To analyze the association of components of the Centers for Disease Control and Prevention (CDC) Environmental Justice Index (EJI) with respiratory health outcomes among infants with bronchopulmonary dysplasia (BPD) within one year after discharge from the neonatal intensive care unit. METHODS This was a retrospective cohort study of a cohort of preterm infants with BPD. Multivariable logistic regression models estimated associations of EJI and its components with medically attended acute respiratory illness, defined as an ED visit or inpatient readmission, within one year of discharge from the neonatal intensive care unit. A mediation analysis was conducted to evaluate how environmental injustice may contribute to racial disparities in acute respiratory illness. RESULTS Greater EJI was associated with an increased risk of medically attended respiratory illness (per EJI standard deviation increment, aOR 1.38, 95% CI: 1.12-1.69). Of the index's components, the Environmental Burden Module's Air pollution domain had the greatest association (aOR 1.44, 95% CI: 1.44-2.61). With respect to individual indicators within the EJI, Diesel Particulate Matter (DSLPM) and Air Toxic Cancer Risk (ATCR) demonstrated the strongest relationship (aOR 2.06, 95% CI: 1.57-2.71 and aOR 2.10, 95% CI: 1.59-2.78, respectively). Among non-Hispanic Black infants, 63% experienced a medically attended acute respiratory illness as compared to 18% of non-Hispanic White infants. DSLPM mediated 39% of the Black-White disparity in medically attended acute respiratory illness (p = 0.004). CONCLUSIONS Environmental exposures, particularly air pollution, are associated with post-discharge respiratory health outcomes among preterm infants with BPD after adjusting for clinical, demographic, and social vulnerability risk factors. Certain types of air pollutants, namely, DSLPM, are more greatly associated with acute respiratory illness. Environmental exposures may contribute to racial disparities in medically attended acute respiratory illness among infants with BPD.
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Affiliation(s)
- Jonathan J. Szeto
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Joshua K. Radack
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA (S.B.D.)
| | - Sara B. DeMauro
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA (S.B.D.)
- Neonatal Follow-Up Program, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Erik A. Jensen
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA (S.B.D.)
- Newborn/Infant Chronic Lung Disease Program, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Kathleen Gibbs
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA (S.B.D.)
- Newborn/Infant Chronic Lung Disease Program, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Nicolas P. Novick
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA (S.B.D.)
| | - Kristan A. Scott
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA (S.B.D.)
| | - Daria C. Murosko
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA (S.B.D.)
- Leonard Davis Institute of Health Economics, Philadelphia, PA 19104, USA
| | - Heather H. Burris
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA (S.B.D.)
- Leonard Davis Institute of Health Economics, Philadelphia, PA 19104, USA
- Center of Excellence in Environmental Toxicology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Timothy D. Nelin
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA (S.B.D.)
- Leonard Davis Institute of Health Economics, Philadelphia, PA 19104, USA
- Center of Excellence in Environmental Toxicology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Massirio P, Cardiello V, Andreato C, Caruggi S, Battaglini M, Calandrino A, Polleri G, Mongelli F, Malova M, Minghetti D, Parodi A, Calevo MG, Tortora D, Rossi A, Ramenghi LA. Ventilatory Support, Extubation, and Cerebral Perfusion Changes in Pre-Term Neonates: A Near Infrared Spectroscopy Study. Neurotrauma Rep 2024; 5:409-416. [PMID: 38655113 PMCID: PMC11035839 DOI: 10.1089/neur.2023.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Early extubation is considered to be beneficial for pre-term neonates. On the other hand, premature extubation can cause lung derecruitment, compromised gas exchange, and need for reintubation, which may be associated with severe brain injury caused by sudden cerebral blood flow changes. We used near infrared spectroscopy (NIRS) to investigate changes in cerebral oxygenation (rScO2) and fractional tissue oxygen extraction (+) after extubation in pre-term infants. This is a single-center retrospective study of NIRS data at extubation time of all consecutive pre-term neonates born at our institution over a 1-year period. Comparison between subgroups was performed. Nineteen patients were included; average gestational age (GA) was 29.4 weeks. No significant change was noted in rScO2 and cFTOE after extubation in the whole population. GA and germinal matrix hemorrhage (GMH)-intraventricular hemorrhage (IVH) showed a significant change in rScO2 and cFTOE after extubation. A significant increase in cFTOE was noted in patients with previous GMH-IVH (+0.040; p = 0.05). To conclude, extubation per se was not associated with significant change in cerebral oxygenation and perfusion. Patients with a diagnosed GMH-IVH showed an increase in cFTOE, suggesting perturbation in cerebral perfusion suggesting further understanding during this challenging phenomenon. Larger studies are required to corroborate our findings.
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Affiliation(s)
- Paolo Massirio
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and University of Genoa, Genoa, Italy
| | - Valentina Cardiello
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Chiara Andreato
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and University of Genoa, Genoa, Italy
| | - Samuele Caruggi
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and University of Genoa, Genoa, Italy
| | - Marcella Battaglini
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and University of Genoa, Genoa, Italy
| | - Andrea Calandrino
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and University of Genoa, Genoa, Italy
| | - Giulia Polleri
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Federica Mongelli
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Mariya Malova
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Diego Minghetti
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alessandro Parodi
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and University of Genoa, Genoa, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistic Unit, Scientific Direction, and IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Luca Antonio Ramenghi
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and University of Genoa, Genoa, Italy
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6
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Rich JM, Lin LJ, Le JL, Abe JRC, Sura A. Assessing the agreement of chronic lung disease of prematurity diagnosis between radiologists and clinical criteria. Matern Health Neonatol Perinatol 2024; 10:8. [PMID: 38575993 PMCID: PMC10996264 DOI: 10.1186/s40748-024-00178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/07/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Chronic lung disease of prematurity (CLD) is the most prevalent complication of preterm birth and indicates an increased likelihood of long-term pulmonary complications. The accurate diagnosis of this condition is critical for long-term health management. Numerous definitions define CLD with different clinical parameters and radiology findings, making diagnosis of the disease ambiguous and potentially inaccurate. METHODS 95 patients were identified for this study, as determined by the diagnosis or confirmation of CLD in the impression of the radiologist's report on chest x-ray. Pulmonary function and complications were recorded at multiple benchmark timeframes within each patient's first few months of life and used for determining eligibility under each definition. RESULTS Each clinical definition of CLD had a high sensitivity for patients identified to have CLD by radiologists, correctly fitting over 90% of patients. Most patients included required invasive mechanical ventilation or positive pressure ventilation at 36 weeks postmenstrual age, indicating patients with radiographically confirmed CLD tended to have more severe disease. Radiologists tended to diagnose CLD before 36 weeks postmenstrual age, a timepoint used by multiple standard clinical definitions, with cases called earlier fitting under a larger percentage of definitions than those called later. CONCLUSIONS Radiologists tend to diagnose CLD in young patients with severe respiratory compromise, and can accurately diagnose the condition before developmental milestones for clinical definitions are met.
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Affiliation(s)
- Joseph Matthew Rich
- USC-Caltech MD/PhD Program, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, 90033, Los Angeles, CA, USA.
| | - Lydia Jing Lin
- USC-Caltech MD/PhD Program, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, 90033, Los Angeles, CA, USA
| | - Jonathan Luan Le
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Amit Sura
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, CA, USA
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7
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Molloy EJ, El-Dib M, Soul J, Juul S, Gunn AJ, Bender M, Gonzalez F, Bearer C, Wu Y, Robertson NJ, Cotton M, Branagan A, Hurley T, Tan S, Laptook A, Austin T, Mohammad K, Rogers E, Luyt K, Wintermark P, Bonifacio SL. Neuroprotective therapies in the NICU in preterm infants: present and future (Neonatal Neurocritical Care Series). Pediatr Res 2024; 95:1224-1236. [PMID: 38114609 PMCID: PMC11035150 DOI: 10.1038/s41390-023-02895-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/19/2023] [Accepted: 10/26/2023] [Indexed: 12/21/2023]
Abstract
The survival of preterm infants has steadily improved thanks to advances in perinatal and neonatal intensive clinical care. The focus is now on finding ways to improve morbidities, especially neurological outcomes. Although antenatal steroids and magnesium for preterm infants have become routine therapies, studies have mainly demonstrated short-term benefits for antenatal steroid therapy but limited evidence for impact on long-term neurodevelopmental outcomes. Further advances in neuroprotective and neurorestorative therapies, improved neuromonitoring modalities to optimize recruitment in trials, and improved biomarkers to assess the response to treatment are essential. Among the most promising agents, multipotential stem cells, immunomodulation, and anti-inflammatory therapies can improve neural outcomes in preclinical studies and are the subject of considerable ongoing research. In the meantime, bundles of care protecting and nurturing the brain in the neonatal intensive care unit and beyond should be widely implemented in an effort to limit injury and promote neuroplasticity. IMPACT: With improved survival of preterm infants due to improved antenatal and neonatal care, our focus must now be to improve long-term neurological and neurodevelopmental outcomes. This review details the multifactorial pathogenesis of preterm brain injury and neuroprotective strategies in use at present, including antenatal care, seizure management and non-pharmacological NICU care. We discuss treatment strategies that are being evaluated as potential interventions to improve the neurodevelopmental outcomes of infants born prematurely.
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Affiliation(s)
- Eleanor J Molloy
- Paediatrics, Trinity College Dublin, Trinity Research in Childhood Centre (TRICC), Dublin, Ireland.
- Children's Hospital Ireland (CHI) at Tallaght, Dublin, Ireland.
- Neonatology, CHI at Crumlin, Dublin, Ireland.
- Neonatology, Coombe Women's and Infants University Hospital, Dublin, Ireland.
| | - Mohamed El-Dib
- Department of Pediatrics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Janet Soul
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sandra Juul
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Alistair J Gunn
- Departments of Physiology and Paediatrics, School of Medical Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Manon Bender
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Fernando Gonzalez
- Department of Neurology, Division of Child Neurology, University of California, San Francisco, California, USA
| | - Cynthia Bearer
- Division of Neonatology, Department of Pediatrics, Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Yvonne Wu
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Nicola J Robertson
- Institute for Women's Health, University College London, London, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Mike Cotton
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Aoife Branagan
- Paediatrics, Trinity College Dublin, Trinity Research in Childhood Centre (TRICC), Dublin, Ireland
- Neonatology, Coombe Women's and Infants University Hospital, Dublin, Ireland
| | - Tim Hurley
- Paediatrics, Trinity College Dublin, Trinity Research in Childhood Centre (TRICC), Dublin, Ireland
| | - Sidhartha Tan
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Abbot Laptook
- Department of Pediatrics, Women and Infants Hospital, Brown University, Providence, Rhode Island, USA
| | - Topun Austin
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Khorshid Mohammad
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Elizabeth Rogers
- Department of Pediatrics, University of California, San Francisco Benioff Children's Hospital, San Francisco, California, USA
| | - Karen Luyt
- Translational Health Sciences, University of Bristol, Bristol, UK
- Neonatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Pia Wintermark
- Division of Neonatology, Montreal Children's Hospital, Montreal, Quebec, Canada
- McGill University Health Centre - Research Institute, Montreal, Quebec, Canada
| | - Sonia Lomeli Bonifacio
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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Ninan K, Liyanage SK, Murphy KE, Asztalos EV, McDonald SD. Long-Term Outcomes of Multiple versus a Single Course of Antenatal Steroids: A Systematic Review. Am J Perinatol 2024; 41:395-404. [PMID: 36724821 DOI: 10.1055/s-0042-1760386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Multiple courses versus a single course of antenatal corticosteroids (ACS) have been associated with mild respiratory benefits but also adverse outcomes like smaller head circumference and birth weight. Long-term effects warrant study. We systematically reviewed long-term outcomes (≥1 year) in both preterm and term birth after exposure to preterm multiple courses (including a rescue dose or course) versus a single course. We searched seven databases from January 2000 to October 2021. We included follow-up studies of randomized controlled trials (RCTs) and cohort studies with births occurring in/after the year 2000, given advances in perinatal care. Two reviewers assessed titles/abstracts, articles, quality, and outcomes including psychological disorders, neurodevelopment, and anthropometry. Six follow-up studies of three RCTs and two cohort studies (over 2,860 children total) met inclusion criteria. Among children born preterm, randomization to multiple courses versus a single course of ACS was not associated with adjusted beneficial or adverse neurodevelopmental/psychological or other outcomes, but data are scant after a rescue dose (120 and 139 children, respectively, low certainty) and nonexistent after a rescue course. For children born at term (i.e., 27% of the multiple courses of ACS 5-year follow-up study of 1,728 preterm/term born children), preterm randomization to multiple courses (at least one additional course) versus a single course was significantly associated with elevated odds of neurosensory impairment (adjusted odds ratio = 3.70, 95% confidence interval: 1.57-8.75; 212 and 247 children, respectively, moderate certainty). In this systematic review of long-term outcomes after multiple courses versus a single course of ACS, there were no significant benefits or risks regarding neurodevelopment in children born preterm but little data after one rescue dose and none after a rescue course. However, multiple courses (i.e., at least one additional course) should be considered cautiously: after term birth, there are no long-term benefits but neurosensory harms. KEY POINTS: · We systematically reviewed the long-term impact of multiple versus a single course of ACS.. · Long-term follow-up data were scant after a rescue dose and absent after one rescue course of ACS.. · In children born preterm, multiple courses of ACS were not associated with long-term benefits/harms.. · In children born at term, multiple courses of ACS were associated with neurosensory impairment.. · Preterm administration of multiple courses of ACS should be considered cautiously..
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Affiliation(s)
- Kiran Ninan
- Department of Obstetrics and Gynecology, McMaster University, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada
| | - Sugee K Liyanage
- Department of Obstetrics and Gynecology, McMaster University, Ontario, Canada
| | - Kellie E Murphy
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth V Asztalos
- Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Sarah D McDonald
- Department of Obstetrics and Gynecology, McMaster University, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada
- Department of Radiology, McMaster University, Ontario, Canada
- Division of Maternal-Fetal Medicine, McMaster University, Ontario, Canada
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9
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Dubner SE, Rickerich L, Bruckert L, Poblaciones RV, Sproul D, Scala M, Feldman HM, Travis KE. Early, low-dose hydrocortisone and near-term brain connectivity in extremely preterm infants. Pediatr Res 2024; 95:1028-1034. [PMID: 38030826 DOI: 10.1038/s41390-023-02903-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Postnatal steroids are used to prevent bronchopulmonary dysplasia in extremely preterm infants but may have adverse effects on brain development. We assessed connectivity metrics of major cerebral and cerebellar white matter pathways at near-term gestational age among infants who did or did not receive a standardized regimen of hydrocortisone during the first 10 days of life. METHODS Retrospective cohort study. PARTICIPANTS Infants born <28 weeks: Protocol group (n = 33) received at least 50% and not more than 150% of an intended standard dose of 0.5 mg/kg hydrocortisone twice daily for 7 days, then 0.5 mg/kg per day for 3 days; Non-Protocol group (n = 22), did not receive protocol hydrocortisone or completed <50% of the protocol dose. We assessed group differences in near-term diffusion MRI mean fractional anisotropy (FA) and mean diffusivity (MD) across the corticospinal tract, inferior longitudinal fasciculus, corpus callosum and superior cerebellar peduncle. RESULTS Groups were comparable in gestational age, post-menstrual age at scan, medical complications, bronchopulmonary dysplasia, and necrotizing enterocolitis. No significant large effect group differences were identified in mean FA or MD in any cerebral or cerebellar tract. CONCLUSION(S) Low dose, early, postnatal hydrocortisone was not associated with significant differences in white matter tract microstructure at near-term gestational age. IMPACT This study compared brain microstructural connectivity as a primary outcome among extremely preterm infants who did or did not receive early postnatal hydrocortisone. Low dose hydrocortisone in the first 10 days of life was not associated with significant differences in white matter microstructure in major cerebral and cerebellar pathways. Hydrocortisone did not have a significant effect on early brain white matter circuits.
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Affiliation(s)
- Sarah E Dubner
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Lucy Rickerich
- Program in Human Biology, Stanford University, Stanford, CA, USA
| | - Lisa Bruckert
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Rocío Velasco Poblaciones
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Dawson Sproul
- Program in Human Biology, Stanford University, Stanford, CA, USA
| | - Melissa Scala
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Heidi M Feldman
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Katherine E Travis
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University, Stanford, CA, USA.
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10
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Litt JS, Halfon N, Msall ME, Russ SA, Hintz SR. Ensuring Optimal Outcomes for Preterm Infants after NICU Discharge: A Life Course Health Development Approach to High-Risk Infant Follow-Up. CHILDREN (BASEL, SWITZERLAND) 2024; 11:146. [PMID: 38397258 PMCID: PMC10886801 DOI: 10.3390/children11020146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 02/25/2024]
Abstract
Children born prematurely (<37 weeks' gestation) have an increased risk for chronic health problems and developmental challenges compared to their term-born peers. The threats to health and development posed by prematurity, the unintended effects of life-sustaining neonatal intensive care, the associated neonatal morbidities, and the profound stressors to families affect well-being during infancy, childhood, adolescence, and beyond. Specialized clinical programs provide medical and developmental follow-up care for preterm infants after hospital discharge. High-risk infant follow-up, like most post-discharge health services, has many shortcomings, including unclear goals, inadequate support for infants, parents, and families, fragmented service provisions, poor coordination among providers, and an artificially foreshortened time horizon. There are well-documented inequities in care access and delivery. We propose applying a life course health development framework to clinical follow-up for children born prematurely that is contextually appropriate, developmentally responsive, and equitably deployed. The concepts of health development, unfolding, complexity, timing, plasticity, thriving, and harmony can be mapped to key components of follow-up care delivery to address pressing health challenges. This new approach envisions a more effective version of clinical follow-up to support the best possible functional outcomes and the opportunity for every premature infant to thrive within their family and community environments over their life course.
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Affiliation(s)
- Jonathan S. Litt
- Division of Newborn Medicine, Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
- Department of Social and Behavioral Pediatrics, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - Neal Halfon
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, CA 90024, USA; (N.H.); (S.A.R.)
- Department of Pediatrics, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA 90024, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA
- Department of Public Policy, UCLA Luskin School of Public Affairs, Los Angeles, CA 90095, USA
| | - Michael E. Msall
- Department of Pediatrics, Sections of Developmental and Behavioral Pediatrics and Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, University of Chicago Medicine, Chicago, IL 60637, USA;
| | - Shirley Ann Russ
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, CA 90024, USA; (N.H.); (S.A.R.)
- Department of Pediatrics, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA 90024, USA
| | - Susan R. Hintz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94305, USA;
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11
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Rallis D, Ben-David D, Woo K, Robinson J, Beadles D, Bernardini L, Abdulhayoglu E, Flanigan E, Christou H. Single center experience with first-intention high-frequency jet vs. volume-targeted ventilation in extremely preterm neonates. Front Pediatr 2024; 11:1326668. [PMID: 38239592 PMCID: PMC10794594 DOI: 10.3389/fped.2023.1326668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/14/2023] [Indexed: 01/22/2024] Open
Abstract
Objectives To examine whether first-intention high-frequency jet ventilation (HFVJ), compared to volume-targeted ventilation (VTV), in extremely preterm infants is associated with lower incidence of bronchopulmonary dysplasia (BPD) and other adverse clinical outcomes. Study design We conducted a retrospective cohort study evaluating neonates with gestational age (GA) ≤28 weeks, who received first-intention HFJV (main exposure) or VTV (comparator), between 11/2020 and 3/2023, with a subgroup analysis including neonates with GA ≤26 weeks and oxygenation index (OI) >5. Results We identified 117 extremely preterm neonates, 24 (GA 25.2 ± 1.6 weeks) on HFJV, and 93 (GA 26.4 ± 1.5 weeks, p = 0.001) on VTV. The neonates in the HFJV group had higher oxygenation indices on admission, higher inotrope use, and remained intubated for a longer period. Despite these differences, there were no statistically significant differences in rates of BPD, survival, or other adverse outcomes between the two groups. In subgroup analysis of 18 neonates on HFJV and 39 neonates on VTV, no differences were recorded in the GA, and duration of mechanical ventilation, while neonates in the HFJV group had significantly lower rates of BPD (50% compared to 83%, p = 0.034), and no significant differences in other adverse outcomes compared to neonates in the VTV group. In neonates ≤26 weeks of GA with OI >5, HFJV was significantly associated with lower rates of BPD (OR 0.21, 95% CI 0.05-0.92), and combined BPD or death (OR 0.18, 95% CI 0.03-0.85), after adjusting for birth weight, and Arterial-alveolar gradient on admission. Conclusions In extremely preterm neonates ≤26 weeks of GA with OI >5, first-intention HFJV, in comparison to VTV, is associated with lower rates of BPD.
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Affiliation(s)
- Dimitrios Rallis
- Department of Pediatrics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
- Neonatal Intensive Care Unit, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Danielle Ben-David
- Department of Pediatrics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Kendra Woo
- Department of Pediatrics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Jill Robinson
- Department of Pediatrics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - David Beadles
- Department of Pediatrics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Laura Bernardini
- Department of Pediatrics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Elisa Abdulhayoglu
- Department of Pediatrics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Elizabeth Flanigan
- Department of Pediatrics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Helen Christou
- Department of Pediatrics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
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12
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Moore SS, De Carvalho Nunes G, Dancea A, Wutthigate P, Simoneau J, Beltempo M, Sant'Anna G, Altit G. Early cardiac function and death, severe bronchopulmonary dysplasia and pulmonary hypertension in extremely preterm infants. Pediatr Res 2024; 95:293-301. [PMID: 37726544 DOI: 10.1038/s41390-023-02817-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 07/15/2023] [Accepted: 08/28/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Association between early cardiac function and neonatal outcomes are scarcely reported. The aim of the current study was to describe this association with death, severe bronchopulmonary dysplasia (BPD) and BPD-related pulmonary hypertension (PH). METHODS Retrospective cohort study of infants <29 weeks born between 2015 and 2019. Infants with clinically acquired echocardiography at ≤21 days after birth were included and data were extracted by an expert masked to outcomes. RESULTS A total of 176 infants were included. Echocardiogram was performed at a median of 9 days (IQR 5-13.5). Of these, 31 (18%) had death/severe BPD and 59 (33.5%) had death/BPD-related PH. Infants with death/severe BPD were of lower birth weight (745 [227] vs 852 [211] grams, p = 0.01) and more exposed to invasive ventilation, late-onset sepsis, inotropes and/or postnatal steroids. Early echocardiograms demonstrated decreased right ventricular [Tricuspid Annular Plane Systolic Excursion: 5.2 (1.4) vs 6.2 (1.5) cm, p = 0.03] and left ventricular function [Ejection fraction 53 (14) vs 58 (10) %, p = 0.03]. Infants with death/BPD-related PH had an increased Eccentricity index (1.35 [0.20] vs 1.26 [0.19], p = 0.02), and flat/bowing septum (19/54 [35%] vs 20/109 [18%], p = 0.021). CONCLUSIONS In extremely premature infants, altered ventricular function and increased pulmonary pressure indices within the first 21 days after birth, were associated with the combined outcome of death/severe BPD and death/BPD-related PH. IMPACT Decreased cardiac function on echocardiography performed during first three weeks of life is associated with severe bronchopulmonary dysplasia in extremely premature infants. In extreme preterm infants, echocardiographic signs of pulmonary hypertension in early life are associated with later BPD-related pulmonary hypertension close to 36 weeks post-menstrual age. Early cardiac markers should be further studied as potential intervention targets in this population. Our study is adding comprehensive analysis of echocardiographic data in infants born below 29 weeks gestational age.
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Affiliation(s)
- Shiran S Moore
- Neonatology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada
- Neonatology-Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Gabriela De Carvalho Nunes
- Neonatology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada
| | - Adrian Dancea
- Pediatric Cardiology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada
| | | | - Jessica Simoneau
- Pediatric Cardiology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada
| | - Marc Beltempo
- Neonatology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada
| | - Guilherme Sant'Anna
- Neonatology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada
| | - Gabriel Altit
- Neonatology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada.
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13
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Huang LY, Lin TI, Lin CH, Yang SN, Chen WJ, Wu CY, Liu HK, Wu PL, Suen JL, Chen JS, Yang YN. Comprehensive Analysis of Risk Factors for Bronchopulmonary Dysplasia in Preterm Infants in Taiwan: A Four-Year Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1822. [PMID: 38002913 PMCID: PMC10670039 DOI: 10.3390/children10111822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/07/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
Bronchopulmonary dysplasia (BPD) is a major respiratory condition mainly affecting premature infants. Although its occurrence is global, risk factors may differ regionally. This study, involving 3111 infants with birth weight ≤ 1500 gm or gestational age (GA) < 30 weeks, aimed to identify risk factors for BPD and BPD/mortality in Taiwan using data from the Taiwan Neonatal Network. The BPD criteria were based on the National Institute of Child Health and Human Development standards. Average GA was 27.5 weeks, with 23.7% classified as small for GA (SGA). Multivariate analysis highlighted low GA, low birth weight, and other perinatal factors as significant risk indicators for BPD. For moderate-to-severe BPD, additional risk factors included male gender and SGA, endotracheal intubation (ETT) or cardiopulmonary cerebral resuscitation (CPCR) in initial resuscitation. In the moderate-to-severe BPD/death group, SGA and ETT or CPCR in initial resuscitation remained the only additional risk factors. The study pinpoints male gender, SGA and ETT or CPCR as key risk factors for moderate-to-severe BPD/death in low-birth-weight infants in Taiwan, offering a basis for focused interventions and further research.
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Affiliation(s)
- Lin-Yi Huang
- Department of Pediatrics, E-DA Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (L.-Y.H.); (T.-I.L.); (C.-H.L.); (S.-N.Y.); (W.-J.C.); (C.-Y.W.); (H.-K.L.); (P.-L.W.)
- School of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Ting-I Lin
- Department of Pediatrics, E-DA Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (L.-Y.H.); (T.-I.L.); (C.-H.L.); (S.-N.Y.); (W.-J.C.); (C.-Y.W.); (H.-K.L.); (P.-L.W.)
- School of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Chyi-Her Lin
- Department of Pediatrics, E-DA Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (L.-Y.H.); (T.-I.L.); (C.-H.L.); (S.-N.Y.); (W.-J.C.); (C.-Y.W.); (H.-K.L.); (P.-L.W.)
- School of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
- Department of Pediatrics, National Cheng-Kung University Hospital, Tainan 70403, Taiwan
| | - San-Nan Yang
- Department of Pediatrics, E-DA Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (L.-Y.H.); (T.-I.L.); (C.-H.L.); (S.-N.Y.); (W.-J.C.); (C.-Y.W.); (H.-K.L.); (P.-L.W.)
- School of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Wan-Ju Chen
- Department of Pediatrics, E-DA Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (L.-Y.H.); (T.-I.L.); (C.-H.L.); (S.-N.Y.); (W.-J.C.); (C.-Y.W.); (H.-K.L.); (P.-L.W.)
- School of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Chien-Yi Wu
- Department of Pediatrics, E-DA Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (L.-Y.H.); (T.-I.L.); (C.-H.L.); (S.-N.Y.); (W.-J.C.); (C.-Y.W.); (H.-K.L.); (P.-L.W.)
- School of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Hsien-Kuan Liu
- Department of Pediatrics, E-DA Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (L.-Y.H.); (T.-I.L.); (C.-H.L.); (S.-N.Y.); (W.-J.C.); (C.-Y.W.); (H.-K.L.); (P.-L.W.)
- School of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Pei-Ling Wu
- Department of Pediatrics, E-DA Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (L.-Y.H.); (T.-I.L.); (C.-H.L.); (S.-N.Y.); (W.-J.C.); (C.-Y.W.); (H.-K.L.); (P.-L.W.)
- School of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Jau-Ling Suen
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan;
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Jung-Sheng Chen
- Department of Medical Research, E-Da Hospital, I-Shou University, Kaohsiung 824005, Taiwan;
| | - Yung-Ning Yang
- Department of Pediatrics, E-DA Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (L.-Y.H.); (T.-I.L.); (C.-H.L.); (S.-N.Y.); (W.-J.C.); (C.-Y.W.); (H.-K.L.); (P.-L.W.)
- School of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
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14
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Nelin TD, Yang N, Radack J, Lorch SA, DeMauro SB, Bamat NA, Jensen EA, Gibbs K, Just AC, Burris HH. Associations of neighborhood social vulnerability with emergency department visits and readmissions among infants with bronchopulmonary dysplasia. J Perinatol 2023; 43:1308-1313. [PMID: 37491473 PMCID: PMC10864938 DOI: 10.1038/s41372-023-01735-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/05/2023] [Accepted: 07/18/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVES To characterize associations of the CDC Social Vulnerability Index (SVI) with medically attended acute respiratory illness among infants with bronchopulmonary dysplasia (BPD). STUDY DESIGN Retrospective cohort of 378 preterm infants with BPD from a single center. Multivariable logistic regression quantified associations of SVI with medically attended acute respiratory illness, defined as emergency department (ED) visits or hospital readmissions within a year after first hospital discharge. Mediation analysis quantified the extent to which differences in SVI may explain known Black-White disparities in medically attended acute respiratory illness. RESULTS SVI was associated with medically attended respiratory illness (per SVI standard deviation increment, aOR 1.44, 95% CI: 1.17-1.78). Adjustment for race and ethnicity attenuated the association (aOR 1.27, 95% CI: 0.97-1.64). SVI significantly mediated 31% of the Black-White disparity in ED visits (p = 0.04). CONCLUSIONS SVI was associated with, and may partially explain racial disparities in, medically attended acute respiratory illness among infants with BPD.
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Affiliation(s)
- Timothy D Nelin
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- Center of Excellence in Environmental Toxicology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Nancy Yang
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joshua Radack
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Scott A Lorch
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
| | - Sara B DeMauro
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Neonatal Follow-Up Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nicolas A Bamat
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Newborn/Infant Chronic Lung Disease Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erik A Jensen
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Newborn/Infant Chronic Lung Disease Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kathleen Gibbs
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Newborn/Infant Chronic Lung Disease Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Allan C Just
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Heather H Burris
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Center of Excellence in Environmental Toxicology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
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15
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Dargaville PA, Kamlin COF, Orsini F, Wang X, De Paoli AG, Kanmaz Kutman HG, Cetinkaya M, Kornhauser-Cerar L, Derrick M, Özkan H, Hulzebos CV, Schmölzer GM, Aiyappan A, Lemyre B, Kuo S, Rajadurai VS, O’Shea J, Biniwale M, Ramanathan R, Kushnir A, Bader D, Thomas MR, Chakraborty M, Buksh MJ, Bhatia R, Sullivan CL, Shinwell ES, Dyson A, Barker DP, Kugelman A, Donovan TJ, Goss KCW, Tauscher MK, Murthy V, Ali SKM, Clark HW, Soll RF, Johnson S, Cheong JLY, Carlin JB, Davis PG. Two-Year Outcomes After Minimally Invasive Surfactant Therapy in Preterm Infants: Follow-Up of the OPTIMIST-A Randomized Clinical Trial. JAMA 2023; 330:1054-1063. [PMID: 37695601 PMCID: PMC10495923 DOI: 10.1001/jama.2023.15694] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/27/2023] [Indexed: 09/12/2023]
Abstract
Importance The long-term effects of surfactant administration via a thin catheter (minimally invasive surfactant therapy [MIST]) in preterm infants with respiratory distress syndrome remain to be definitively clarified. Objective To examine the effect of MIST on death or neurodevelopmental disability (NDD) at 2 years' corrected age. Design, Setting, and Participants Follow-up study of a randomized clinical trial with blinding of clinicians and outcome assessors conducted in 33 tertiary-level neonatal intensive care units in 11 countries. The trial included 486 infants with a gestational age of 25 to 28 weeks supported with continuous positive airway pressure (CPAP). Collection of follow-up data at 2 years' corrected age was completed on December 9, 2022. Interventions Infants assigned to MIST (n = 242) received exogenous surfactant (200 mg/kg poractant alfa) via a thin catheter; those assigned to the control group (n = 244) received sham treatment. Main Outcomes and Measures The key secondary outcome of death or moderate to severe NDD was assessed at 2 years' corrected age. Other secondary outcomes included components of this composite outcome, as well as hospitalizations for respiratory illness and parent-reported wheezing or breathing difficulty in the first 2 years. Results Among the 486 infants randomized, 453 had follow-up data available (median gestation, 27.3 weeks; 228 females [50.3%]); data on the key secondary outcome were available in 434 infants. Death or NDD occurred in 78 infants (36.3%) in the MIST group and 79 (36.1%) in the control group (risk difference, 0% [95% CI, -7.6% to 7.7%]; relative risk [RR], 1.0 [95% CI, 0.81-1.24]); components of this outcome did not differ significantly between groups. Secondary respiratory outcomes favored the MIST group. Hospitalization with respiratory illness occurred in 49 infants (25.1%) in the MIST group vs 78 (38.2%) in the control group (RR, 0.66 [95% CI, 0.54-0.81]) and parent-reported wheezing or breathing difficulty in 73 (40.6%) vs 104 (53.6%), respectively (RR, 0.76 [95% CI, 0.63-0.90]). Conclusions and Relevance In this follow-up study of a randomized clinical trial of preterm infants with respiratory distress syndrome supported with CPAP, MIST compared with sham treatment did not reduce the incidence of death or NDD by 2 years of age. However, infants who received MIST had lower rates of adverse respiratory outcomes during their first 2 years of life. Trial Registration anzctr.org.au Identifier: ACTRN12611000916943.
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Affiliation(s)
- Peter A. Dargaville
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - C. Omar F. Kamlin
- Neonatal Services, Royal Women’s Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Francesca Orsini
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Xiaofang Wang
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Antonio G. De Paoli
- Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - H. Gozde Kanmaz Kutman
- Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Merih Cetinkaya
- Division of Neonatology, Department of Pediatrics, Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Lilijana Kornhauser-Cerar
- Division of Gynaecology and Obstetrics, Department of Perinatology, University Medical Centre, Ljubljana, Slovenia
| | - Matthew Derrick
- Division of Neonatology, Northshore University Health System, Evanston, Illinois
| | - Hilal Özkan
- Division of Neonatology, Department of Pediatrics, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Christian V. Hulzebos
- Division of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - Georg M. Schmölzer
- Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Ajit Aiyappan
- Neonatal Services, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Brigitte Lemyre
- Department of Obstetrics, Gynecology, and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sheree Kuo
- Department of Pediatrics, Kapiʻolani Medical Center for Women and Children, Honolulu, Hawaiʻi
| | - Victor S. Rajadurai
- Department of Neonatology, KK Women’s and Children’s Hospital, Duke-NUS Medical School, Singapore
| | - Joyce O’Shea
- Neonatal Unit, Royal Hospital for Children, Glasgow, United Kingdom
| | - Manoj Biniwale
- Division of Neonatology, Department of Pediatrics, Los Angeles County + USC Medical Center and Good Samaritan Hospital, Keck School of Medicine of USC, Los Angeles, California
| | - Rangasamy Ramanathan
- Division of Neonatology, Department of Pediatrics, Los Angeles County + USC Medical Center and Good Samaritan Hospital, Keck School of Medicine of USC, Los Angeles, California
| | - Alla Kushnir
- Department of Pediatrics, Children’s Regional Hospital, Cooper University Health Care, Camden, New Jersey
| | - David Bader
- Rappaport Faculty of Medicine, Department of Neonatology, Bnai Zion Medical Center, Technion, Haifa, Israel
| | - Mark R. Thomas
- Department of Neonatal Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Mallinath Chakraborty
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, United Kingdom
| | - Mariam J. Buksh
- Newborn Service, Starship Child Health, Auckland Hospital, Auckland, New Zealand
| | - Risha Bhatia
- Monash Newborn, Monash Children’s Hospital, Clayton, Victoria, Australia
| | - Carol L. Sullivan
- Department of Neonatology, Singleton Hospital, Swansea, United Kingdom
| | - Eric S. Shinwell
- Faculty of Medicine, Department of Neonatology, Ziv Medical Center, Bar-Ilan University, Tsfat, Israel
| | - Amanda Dyson
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Woden, New South Wales, Australia
| | - David P. Barker
- Neonatal Intensive Care Unit, Dunedin Hospital, Dunedin, New Zealand
| | - Amir Kugelman
- Rappaport Faculty of Medicine, Department of Neonatology, Rambam Medical Center, Technion, Haifa, Israel
| | - Tim J. Donovan
- Division of Neonatology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Kevin C. W. Goss
- Neonatal Intensive Care Unit, Princess Anne Hospital, Southampton, United Kingdom
| | - Markus K. Tauscher
- Division of Neonatology, Peyton Manning Children’s Hospital, Ascension St Vincent, Indianapolis, Indiana
| | - Vadivelam Murthy
- Neonatal Intensive Care Centre, The Royal London Hospital-Barts Health NHS Foundation Trust, London, United Kingdom
| | | | - Howard W. Clark
- Faculty of Population Health Sciences, Neonatology, EGA Institute for Women’s Health, University College London, London, United Kingdom
| | - Roger F. Soll
- Division of Neonatal-Perinatal Medicine, Larner College of Medicine, The University of Vermont, Burlington
| | - Samantha Johnson
- Infant Mortality and Morbidity Studies Research Group, Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Jeanie L. Y. Cheong
- Neonatal Services, Royal Women’s Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - John B. Carlin
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter G. Davis
- Neonatal Services, Royal Women’s Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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16
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Callahan KP, Kielt MJ, Feudtner C, Barkman D, Bamat N, Fierro J, Fiest E, DeMauro SB. Ranking Future Outcomes Most Important to Parents of Children with Bronchopulmonary Dysplasia. J Pediatr 2023; 259:113455. [PMID: 37172804 PMCID: PMC10524943 DOI: 10.1016/j.jpeds.2023.113455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/06/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To assess which potential future outcomes are most important to parents of children with bronchopulmonary dysplasia, a disease that affects future respiratory, medical, and developmental outcomes for children born preterm. STUDY DESIGN We recruited parents from 2 children's hospitals' neonatal follow-up clinics and elicited their importance rating for 20 different potential future outcomes associated with bronchopulmonary dysplasia. These outcomes were identified and selected through a literature review and discussions with panels of parents and clinician stakeholders, via a discrete choice experiment. RESULTS One hundred and 5 parents participated. Overall, parents ranked "Will my child be more vulnerable to other problems because of having lung disease?" as the most important outcome, with other respiratory health related outcomes also highly ranked. Outcomes related to child development and effects on the family were among the lowest ranked. Individually, parents rated outcomes differently, resulting in a broad distribution of importance scores for many of the outcomes. CONCLUSIONS The overall rankings suggest that parents prioritize future outcomes related to physical health and safety. Notably, for guiding research, some top-rated outcomes are not traditionally measured in outcome studies. For guiding individual counseling, the broad distribution of importance scores for many outcomes highlights the extent to which parents differ in their prioritization of outcomes.
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Affiliation(s)
- Katharine Press Callahan
- Children's Hospital of Philadelphia; Philadelphia, PA; Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania; Philadelphia, PA.
| | | | - Chris Feudtner
- Children's Hospital of Philadelphia; Philadelphia, PA; Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania; Philadelphia, PA
| | | | - Nicolas Bamat
- Children's Hospital of Philadelphia; Philadelphia, PA
| | - Julie Fierro
- Children's Hospital of Philadelphia; Philadelphia, PA
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17
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Manley BJ, Kamlin COF, Donath S, Huang L, Birch P, Cheong JLY, Dargaville PA, Dawson JA, Doyle LW, Jacobs SE, Wilson R, Davis PG, McKinlay CJD. Intratracheal budesonide mixed with surfactant to increase survival free of bronchopulmonary dysplasia in extremely preterm infants: study protocol for the international, multicenter, randomized PLUSS trial. Trials 2023; 24:320. [PMID: 37161488 PMCID: PMC10169381 DOI: 10.1186/s13063-023-07257-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 03/14/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD), an inflammatory-mediated chronic lung disease, is common in extremely preterm infants born before 28 weeks' gestation and is associated with an increased risk of adverse neurodevelopmental and respiratory outcomes in childhood. Effective and safe prophylactic therapies for BPD are urgently required. Systemic corticosteroids reduce rates of BPD in the short-term but are associated with poorer neurodevelopmental outcomes if given to ventilated infants in the first week after birth. Intratracheal administration of corticosteroid admixed with exogenous surfactant could overcome these concerns by minimizing systemic sequelae. Several small, randomized trials have found intratracheal budesonide in a surfactant vehicle to be a promising therapy to increase survival free of BPD. METHODS An international, multicenter, double-blinded, randomized trial of intratracheal budesonide (a corticosteroid) mixed with surfactant for extremely preterm infants to increase survival free of BPD at 36 weeks' postmenstrual age (PMA; primary outcome). Extremely preterm infants aged < 48 h after birth are eligible if: (1) they are mechanically ventilated, or (2) they are receiving non-invasive respiratory support and there is a clinical decision to treat with surfactant. The intervention is budesonide (0.25 mg/kg) mixed with poractant alfa (200 mg/kg first intervention, 100 mg/kg if second intervention), administered intratracheally via an endotracheal tube or thin catheter. The comparator is poractant alfa alone (at the same doses). Secondary outcomes include the components of the primary outcome (death, BPD prior to or at 36 weeks' PMA), potential systemic side effects of corticosteroids, cost-effectiveness, early childhood health until 2 years of age, and neurodevelopmental outcomes at 2 years of age (corrected for prematurity). DISCUSSION Combining budesonide with surfactant for intratracheal administration is a simple intervention that may reduce BPD in extremely preterm infants and translate into health benefits in later childhood. The PLUSS trial is powered for the primary outcome and will address gaps in the evidence due to its pragmatic and inclusive design, targeting all extremely preterm infants regardless of their initial mode of respiratory support. Should intratracheal budesonide mixed with surfactant increase survival free of BPD, without severe adverse effects, this readily available intervention could be introduced immediately into clinical practice. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ( https://www.anzctr.org.au ), ACTRN12617000322336. First registered on 28th February 2017.
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Affiliation(s)
- Brett J Manley
- The Royal Women's Hospital, Department of Obstetrics and Gynaecology, The University of Melbourne, Murdoch Children's Research Institute, Melbourne, Australia.
| | - C Omar F Kamlin
- The Royal Women's Hospital, Department of Obstetrics and Gynaecology, The University of Melbourne, Murdoch Children's Research Institute, Melbourne, Australia
| | - Susan Donath
- Department of Paediatrics, Murdoch Children's Research Institute, the University of Melbourne, Melbourne, Australia
| | - Li Huang
- The University of Melbourne, Melbourne, Australia
| | - Pita Birch
- Department of Neonatology, Mater Mother's Hospitals South Brisbane, Brisbane, Australia
| | - Jeanie L Y Cheong
- The Royal Women's Hospital, Department of Obstetrics and Gynaecology, The University of Melbourne, Murdoch Children's Research Institute, Melbourne, Australia
| | - Peter A Dargaville
- Royal Hobart Hospital, Hobart, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Jennifer A Dawson
- The Royal Women's Hospital, Department of Obstetrics and Gynaecology, The University of Melbourne, Murdoch Children's Research Institute, Melbourne, Australia
| | - Lex W Doyle
- The Royal Women's Hospital, Department of Obstetrics and Gynaecology, The University of Melbourne, Murdoch Children's Research Institute, Melbourne, Australia
| | - Susan E Jacobs
- The Royal Women's Hospital, Department of Obstetrics and Gynaecology, The University of Melbourne, Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Peter G Davis
- The Royal Women's Hospital, Department of Obstetrics and Gynaecology, The University of Melbourne, Murdoch Children's Research Institute, Melbourne, Australia
| | - Christopher J D McKinlay
- Department of Paediatrics: Child and Youth Health, the University of Auckland, Kidz First Neonatal Care, TeWhatu Ora Counties Manukau, Auckland, New Zealand
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18
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Litt JS, Johnson S, Marlow N, Tiemeier H. Impaired pulmonary function mediates inattention in young adults born extremely preterm. Acta Paediatr 2023; 112:254-260. [PMID: 36330674 DOI: 10.1111/apa.16586] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/17/2022] [Accepted: 11/03/2022] [Indexed: 11/06/2022]
Abstract
AIM To test whether poor childhood pulmonary function explains the relationship between extremely preterm (EP) birth and attention-deficit/hyperactivity disorder (ADHD) symptoms in young adulthood. METHODS EPICure birth cohort participants include children born <26 weeks' gestation in the United Kingdom and Ireland in 1995 and their term-born classmates. Predictor was EP birth. Outcomes were inattention/hyperactivity subscale z-scores at 19 years. Forced expiratory volume (FEV1) z-scores in childhood and young adulthood were mediators. We used recursive path analysis to determine the direct effect of EP birth on inattention/hyperactivity and its indirect effect through pulmonary function. RESULTS Ninety EP and 47 term-born participants had pulmonary function testing at 11 and 19 years. Inattention z-scores were higher in the EP group (mean difference 0.55 [95% CI 0.11, 0.99]) but not hyperactivity. Compared to term-born peers, EP participants had lower FEV1 z-scores at 11 (mean difference-1.35 [95% CI -1.72, -0.98]) and 19 (mean difference-1.29 [95% CI -1.65, -0.92]). Path models revealed that childhood pulmonary function explained the relationship between EP birth and inattention. CONCLUSIONS Extremely preterm young adults have increased risk for inattention compared to term-born peers. Poor pulmonary function appears to underlie this risk. The mechanisms responsible remain unclear and warrant further study.
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Affiliation(s)
- Jonathan S Litt
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Neil Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Henning Tiemeier
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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19
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Hwang JK, Shin SH, Kim EK, Kim SH, Kim HS. Association of newer definitions of bronchopulmonary dysplasia with pulmonary hypertension and long-term outcomes. Front Pediatr 2023; 11:1108925. [PMID: 36873629 PMCID: PMC9977292 DOI: 10.3389/fped.2023.1108925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 01/11/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND The definition of bronchopulmonary dysplasia (BPD) has been evolved recently from definition by the National Institute of Child Health and Human Development in 2001 (NICHD 2001) to the definition reported in 2018 (NICHD 2018) and that proposed by Jensen et al. in 2019 (NICHD 2019). The definition was developed based on the evolution of non-invasive respiratory support and to achieve better prediction of later outcomes. Our objective was to evaluate the association between different definitions of BPD and occurrence of pulmonary hypertension (PHN) and long term outcomes. METHODS This retrospective study enrolled preterm infants born at < 32 weeks of gestation between 2014 and 2018. The association between re-hospitalization owing to a respiratory illness until a corrected age (CA) of 24 months, neurodevelopmental impairment (NDI) at a CA of 18-24 months, and PHN at a postmenstrual age (PMA) of 36 weeks was evaluated, with the severity of BPD defined based on these three definitions. RESULTS Among 354 infants, the gestational age and birth weight were the lowest in severe BPD based on the NICHD 2019 definition. In total, 14.1% of the study population experienced NDI and 19.0% were re-hospitalized owing to a respiratory illness. At a PMA of 36 weeks, PHN was identified in 9.2% of infants with any BPD. Multiple logistic regression analysis showed that the adjusted odds ratio (OR) for re-hospitalization was the highest for Grade 3 BPD of the NICHD 2019 criteria (5.72, 95% confidence interval [CI]: 1.37-23.92), while the adjusted OR of Grade 3 BPD was 4.96 (95% CI: 1.73-14.23) in the NICHD 2018 definition. Moreover, no association of the severity of BPD was found in the NICHD 2001 definition. The adjusted ORs for NDI (12.09, 95% CI: 2.52-58.05) and PHN (40.37, 95% CI: 5.15-316.34) were also the highest for Grade 3 of the NICHD 2019 criteria. CONCLUSION Based on recently suggested criteria by the NICHD in 2019, BPD severity is associated with long-term outcomes and PHN at a PMA of 36 weeks in preterm infants.
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Affiliation(s)
- Jae Kyoon Hwang
- Department of Pediatrics, Hanyang University Guri Hospital, Gyeonggi-do, Republic of Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seh Hyun Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
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20
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Yao S, Uthaya S, Gale C, Modi N, Battersby C. Postnatal corticosteroid use for prevention or treatment of bronchopulmonary dysplasia in England and Wales 2012-2019: a retrospective population cohort study. BMJ Open 2022; 12:e063835. [PMID: 36396314 PMCID: PMC9676997 DOI: 10.1136/bmjopen-2022-063835] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Describe the population of babies who do and do not receive postnatal corticosteroids for prevention or treatment of bronchopulmonary dysplasia (BPD). DESIGN Retrospective cohort study using data held in the National Neonatal Research Database. SETTING National Health Service neonatal units in England and Wales. PATIENTS Babies born less than 32 weeks gestation and admitted to neonatal units from 1 January 2012 to 31 December 2019. MAIN OUTCOMES Proportion of babies given postnatal corticosteroid; type of corticosteroid; age at initiation and duration, trends over time. SECONDARY OUTCOMES Survival to discharge, treatment for retinopathy of prematurity, BPD, brain injury, severe necrotising enterocolitis, gastrointestinal perforation. RESULTS 8% (4713/62019) of babies born <32 weeks and 26% (3525/13527) born <27 weeks received postnatal corticosteroids for BPD. Dexamethasone was predominantly used 5.3% (3309/62019), followed by late hydrocortisone 1.5%, inhaled budesonide 1.5%. prednisolone 0.8%, early hydrocortisone 0.3% and methylprednisolone 0.05%. Dexamethasone use increased over time (2012: 4.5 vs 2019: 5.8%, p=0.04). Median postnatal age of initiation of corticosteroid course was around 3 weeks for late hydrocortisone, 4 weeks for dexamethasone, 6 weeks for inhaled budesonide, 12 weeks for prednisolone and 16 weeks for methylprednisolone. Babies who received postnatal corticosteroids were born more prematurely, had a higher incidence of comorbidities and a longer length of stay. CONCLUSIONS In England and Wales, around 1 in 12 babies born less than 32 weeks and 1 in 4 born less than 27 weeks receive postnatal corticosteroids to prevent or treat BPD. Given the lack of convincing evidence of efficacy, challenges of recruiting to and length of time taken to conduct randomised controlled trial, our data highlight the need to monitor long-term outcomes in children who received neonatal postnatal corticosteroids.
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Affiliation(s)
- Sijia Yao
- Neonatal Medicine, Imperial College London, London, UK
| | - Sabita Uthaya
- Neonatal Medicine, School of Public Health, Imperial College London, London, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Imperial College London, London, UK
| | - Neena Modi
- Neonatal Medicine, School of Public Health, Imperial College London, London, UK
| | - Cheryl Battersby
- Neonatal Medicine, School of Public Health, Imperial College London, London, UK
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21
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He F, Wu D, Sun Y, Lin Y, Wen X, Cheng ASK. Predictors of extubation outcomes among extremely and very preterm infants: a retrospective cohort study. J Pediatr (Rio J) 2022; 98:648-654. [PMID: 35640721 PMCID: PMC9617279 DOI: 10.1016/j.jped.2022.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To explore the clinical or sociodemographic predictors for both successful and failed extubation among Chinese extremely and very preterm infants METHODS: A retrospective cohort study was carried out among extremely and very preterm infants born at less than 32 weeks of gestational age (GA). RESULTS Compared with the infants who experienced extubation failure, the successful infants had higher birth weight (OR 0.997; CI 0.996-0.998), higher GA (OR 0.582; 95% CI 0.499-0.678), a caesarean section delivery (OR 0.598; 95% CI 0.380-0.939), a higher five-minute Apgar score (OR 0.501; 95% CI 0.257-0.977), and a higher pH prior to extubation (OR 0.008; 95% CI 0.001-0.058). Failed extubation was associated with older mothers (OR 1.055; 95% CI 1.013-1.099), infants intubated in the delivery room (OR 2.820; 95% CI 1.742-4.563), a higher fraction of inspired oxygen (FiO2) prior to extubation (OR 5.246; 95% CI 2.540-10.835), higher partial pressure of carbon dioxide (PCO2) prior to extubation (OR 7.820; 95% CI 3.725-16.420), and higher amounts of lactic acid (OR 1.478;95% CI 1.063-2.056). CONCLUSIONS Higher GA, higher pre-extubation pH, lower pre-extubation FiO2 and PCO, and lower age at extubation are significant predictors of successful extubation among extremely and very preterm infants.
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Affiliation(s)
- Fang He
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Neonatal Intensive Care Unit, Guangzhou, China
| | - Dehua Wu
- Guangzhou Women and Children's Medical Center, Institute of Pediatrics, Clinical Data Center, Guangzhou Medical University, Guangzhou, China
| | - Yi Sun
- Guangzhou Women and Children's Medical Center, Institute of Pediatrics, Clinical Data Center, Guangzhou Medical University, Guangzhou, China
| | - Yan Lin
- Guangzhou Women and Children's Medical Center, Department of Nursing, Guangzhou Medical University, Guangzhou, China.
| | - Xiulan Wen
- Guangzhou Women and Children's Medical Center, Department of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Andy S K Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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22
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Jiang JK, Wang C, Jiang ZD. Postnatal abnormality in brainstem neural conduction in neonatal bronchopulmonary dysplasia survivors. Pediatr Res 2022; 93:1679-1686. [PMID: 36042331 DOI: 10.1038/s41390-022-02222-5] [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: 02/03/2022] [Revised: 05/12/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate postnatal neural conduction in the auditory brainstem in neonatal bronchopulmonary dysplasia (BPD) survivors. METHODS Thirty-two very preterm BPD survivors were studied at 57-58 weeks of postconceptional age. Brainstem auditory-evoked response was studied using maximum length sequence. Wave latencies and intervals were analyzed in detail. The controls were 37 normal term infants and 35 very preterm non-BPD infants. RESULTS Compared with normal term controls, BPD survivors showed significantly shortened I-III interval but significantly prolonged III-V interval and greater III-V/I-III interval ratio. Compared with very preterm non-BPD controls, BPD survivors showed a significant shortening in waves III latency and I-III interval, moderate prolonged III-V interval, and significantly greater III-V/I-III interval ratio. These differences were generally similar at all click rates used. The slopes of latency- and interval-click rate functions in BPD survivors did not differ significantly from the two control groups. CONCLUSIONS Brainstem neural conduction in BPD survivors differed from normal term and age-matched non-BPD infants; neural maturation is accelerated in caudal brainstem regions but delayed in rostral regions. Neonatal BPD survivors are associated with differential maturation in neural conduction at caudal and rostral brainstem regions, which may constitute an important risk for postnatal neurodevelopment in BPD survivors. IMPACT We found that brainstem neural conduction at PCA 57-58 weeks in neonatal BPD survivors differs from normal term and age-matched non-BPD infants. No major differences were found between normal term and very preterm non-BPD infants in brainstem auditory conduction. Neural conduction in BPD survivors is accelerated in caudal brainstem regions but delayed in rostral regions. Neonatal BPD survivors are associated with differential maturation in neural conduction at caudal and rostral brainstem regions. The abnormality may constitute an important risk for postnatal neurodevelopment in BPD survivors.
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Affiliation(s)
- James Ken Jiang
- Division of Neonatology, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201112, China
| | - Cui Wang
- Division of Neonatology, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201112, China
| | - Ze Dong Jiang
- Division of Neonatology, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201112, China.
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23
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Guillot M, Synnes A, Pronovost E, Qureshi M, Daboval T, Caouette G, Olivier F, Bartholomew J, Mohamed I, Massé E, Afifi J, Hendson L, Lemyre B, Luu TM, Strueby L, Cieslak Z, Yusuf K, Pelligra G, Ducruet T, Ndiaye ABKT, Angoa G, Sériès T, Piedboeuf B, Nuyt AM, Fraser W, Mâsse B, Lacaze-Masmonteil T, Lavoie PM, Marc I. Maternal High-Dose DHA Supplementation and Neurodevelopment at 18-22 Months of Preterm Children. Pediatrics 2022; 150:188230. [PMID: 35652296 DOI: 10.1542/peds.2021-055819] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine whether maternal supplementation with high-dose docosahexaenoic acid (DHA) in breastfed, very preterm neonates improves neurodevelopmental outcomes at 18 to 22 months' corrected age (CA). METHODS Planned follow-up of a randomized, double-blind, placebo-controlled, multicenter trial to compare neurodevelopmental outcomes in breastfed, preterm neonates born before 29 weeks' gestational age (GA). Lactating mothers were randomized to receive either DHA-rich algae oil or a placebo within 72 hours of delivery until 36 weeks' postmenstrual age. Neurodevelopmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development third edition (Bayley-III) at 18 to 22 months' CA. Planned subgroup analyses were conducted for GA (<27 vs ≥27 weeks' gestation) and sex. RESULTS Among the 528 children enrolled, 457 (86.6%) had outcomes available at 18 to 22 months' CA (DHA, N = 234, placebo, N = 223). The mean differences in Bayley-III between children in the DHA and placebo groups were -0.07 (95% confidence interval [CI] -3.23 to 3.10, P = .97) for cognitive score, 2.36 (95% CI -1.14 to 5.87, P = .19) for language score, and 1.10 (95% CI -2.01 to 4.20, P = .49) for motor score. The association between treatment and the Bayley-III language score was modified by GA at birth (interaction P = .07). Neonates born <27 weeks' gestation exposed to DHA performed better on the Bayley-III language score, compared with the placebo group (mean difference 5.06, 95% CI 0.08-10.03, P = .05). There was no interaction between treatment group and sex. CONCLUSIONS Maternal DHA supplementation did not improve neurodevelopmental outcomes at 18 to 22 months' CA in breastfed, preterm neonates, but subgroup analyses suggested a potential benefit for language in preterm neonates born before 27 weeks' GA.
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Affiliation(s)
- Mireille Guillot
- Faculty of Medicine, Department of Pediatrics, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Quebec, Canada
| | - Anne Synnes
- Department of Pediatrics, Division of Neonatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Etienne Pronovost
- Faculty of Medicine, Department of Pediatrics, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Quebec, Canada
| | - Mosarrat Qureshi
- Division of Neonatology, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Thierry Daboval
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Georges Caouette
- Faculty of Medicine, Department of Pediatrics, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Quebec, Canada
| | | | - Julie Bartholomew
- Department of Neonatology, Jewish General Hospital, McGill University, Montréal, Quebec, Canada
| | - Ibrahim Mohamed
- Department of Pediatrics, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
| | - Edith Massé
- Department of Pediatrics, Université de Sherbrooke, Hôpital Fleurimont, Sherbrooke, Quebec, Canada
| | - Jehier Afifi
- Department of Pediatrics, Dalhousie University, Halifax, Novia Scotia, Canada
| | - Leonora Hendson
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, University of Calgary, Alberta, Calgary, Canada
| | - Brigitte Lemyre
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
| | - Lannae Strueby
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Zenon Cieslak
- Department of Pediatrics, Royal Columbian Hospital, New Westminster, British Columbia Canada
| | - Kamran Yusuf
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, University of Calgary, Alberta, Calgary, Canada
| | - Gustavo Pelligra
- Department of Maternity Care & Pediatrics, Victoria General Hospital, Island Health, Victoria, British Columbia, Canada
| | - Thierry Ducruet
- Unité de Recherche Clinique Appliquée, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
| | | | - Georgina Angoa
- Faculty of Medicine, Department of Pediatrics, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Quebec, Canada
| | - Thibaut Sériès
- School of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Bruno Piedboeuf
- Faculty of Medicine, Department of Pediatrics, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Quebec, Canada
| | - Anne Monique Nuyt
- Department of Pediatrics, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
| | - William Fraser
- Department of Obstetrics and Gynecology, Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec Canada
| | - Benoît Mâsse
- Unité de Recherche Clinique Appliquée, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada.,School of Public Health, Université de Montréal, Montréal, Quebec, Canada
| | - Thierry Lacaze-Masmonteil
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, University of Calgary, Alberta, Calgary, Canada
| | - Pascal M Lavoie
- Department of Pediatrics, Division of Neonatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Isabelle Marc
- Faculty of Medicine, Department of Pediatrics, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Quebec, Canada
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24
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Abiramalatha T, Ramaswamy VV, Bandyopadhyay T, Somanath SH, Shaik NB, Pullattayil AK, Weiner GM. Interventions to Prevent Bronchopulmonary Dysplasia in Preterm Neonates: An Umbrella Review of Systematic Reviews and Meta-analyses. JAMA Pediatr 2022; 176:502-516. [PMID: 35226067 DOI: 10.1001/jamapediatrics.2021.6619] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Bronchopulmonary dysplasia (BPD) has multifactorial etiology and long-term adverse consequences. An umbrella review enables the evaluation of multiple proposed interventions for the prevention of BPD. OBJECTIVE To summarize and assess the certainty of evidence of interventions proposed to decrease the risk of BPD from published systematic reviews. DATA SOURCES MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, and Web of Science were searched from inception until November 9, 2020. STUDY SELECTION Meta-analyses of randomized clinical trials comparing interventions in preterm neonates that included BPD as an outcome. DATA EXTRACTION AND SYNTHESIS Data extraction was performed in duplicate. Quality of systematic reviews was evaluated using Assessment of Multiple Systematic Reviews version 2, and certainty of evidence was assessed using Grading of Recommendation, Assessment, Development, and Evaluation. MAIN OUTCOMES AND MEASURES (1) BPD or mortality at 36 weeks' postmenstrual age (PMA) and (2) BPD at 36 weeks' PMA. RESULTS A total of 154 systematic reviews evaluating 251 comparisons were included, of which 110 (71.4%) were high-quality systematic reviews. High certainty of evidence from high-quality systematic reviews indicated that delivery room continuous positive airway pressure compared with intubation with or without routine surfactant (relative risk [RR], 0.80 [95% CI, 0.68-0.94]), early selective surfactant compared with delayed selective surfactant (RR, 0.83 [95% CI, 0.75-0.91]), early inhaled corticosteroids (RR, 0.86 [95% CI, 0.75-0.99]), early systemic hydrocortisone (RR, 0.90 [95% CI, 0.82-0.99]), avoiding endotracheal tube placement with delivery room continuous positive airway pressure and use of less invasive surfactant administration (RR, 0.90 [95% CI, 0.82-0.99]), and volume-targeted compared with pressure-limited ventilation (RR, 0.73 [95% CI, 0.59-0.89]) were associated with decreased risk of BPD or mortality at 36 weeks' PMA. Moderate to high certainty of evidence showed that inhaled nitric oxide, lower saturation targets (85%-89%), and vitamin A supplementation are associated with decreased risk of BPD at 36 weeks' PMA but not the competing outcome of BPD or mortality, indicating they may be associated with increased mortality. CONCLUSIONS AND RELEVANCE A multipronged approach of delivery room continuous positive airway pressure, early selective surfactant administration with less invasive surfactant administration, early hydrocortisone prophylaxis in high-risk neonates, inhaled corticosteroids, and volume-targeted ventilation for preterm neonates requiring invasive ventilation may decrease the combined risk of BPD or mortality at 36 weeks' PMA.
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Affiliation(s)
- Thangaraj Abiramalatha
- Department of Neonatology, Kovai Medical Center and Hospital (KMCH) & KMCH Institute of Health Sciences and Research, Coimbatore, India
| | | | - Tapas Bandyopadhyay
- Department of Neonatology, Dr Ram Manohar Lohia Hospital & Post Graduate Institute of Medical Education and Research, New Delhi, India
| | | | | | | | - Gary M Weiner
- Department of Pediatrics-Neonatology, University of Michigan, Ann Arbor
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25
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Puia-Dumitrescu M, Wood TR, Comstock BA, Law JB, German K, Perez KM, Gogcu S, Mayock DE, Heagerty PJ, Juul SE. Dexamethasone, Prednisolone, and Methylprednisolone Use and 2-Year Neurodevelopmental Outcomes in Extremely Preterm Infants. JAMA Netw Open 2022; 5:e221947. [PMID: 35275165 PMCID: PMC8917427 DOI: 10.1001/jamanetworkopen.2022.1947] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Practice variability exists in the use of corticosteroids to treat or prevent bronchopulmonary dysplasia in extremely preterm infants, but there is limited information on longer-term impacts. OBJECTIVE To describe the use of corticosteroids in extremely preterm infants and evaluate the association with neurodevelopmental outcomes. DESIGN, SETTING, AND PARTICIPANTS This cohort study was a secondary analysis of data from the Preterm Erythropoietin Neuroprotection (PENUT) randomized clinical trial, conducted at 19 participating sites and 30 neonatal intensive care units (NICUs) in the US. Inborn infants born between 24 0/7 and 27 6/7 weeks gestational age between December 2013 and September 2016 were included in analysis. Data analysis was conducted between February 2021 and January 2022. EXPOSURES Cumulative dose of dexamethasone and duration of therapy for dexamethasone and prednisolone or methyl prednisolone were evaluated. MAIN OUTCOMES AND MEASURES Demographic and clinical characteristics were described in infants who did or did not receive corticosteroids of interest and survived to discharge. Neurodevelopmental outcomes at 2 years of age were evaluated using the Bayley Scales of Infant Development-Third Edition (BSID-III) at corrected age 2 years. RESULTS A total of 828 extremely preterm infants (403 [49%] girls; median [IQR] gestational age, 26 [25-27] weeks) born at 19 sites who survived to discharge were included in this analysis, and 312 infants (38%) were exposed to at least 1 corticosteroid of interest during their NICU stay, including 279 exposed to dexamethasone, 137 exposed to prednisolone or methylprednisolone, and 79 exposed to both. Exposed infants, compared with nonexposed infants, had a lower birth weight (mean [SD], 718 [168] g vs 868 [180] g) and were born earlier (mean [SD] gestational age, 25 [1] weeks vs 26 [1] weeks). The median (IQR) start day was 29 (20-44) days for dexamethasone and 53 (30-90) days for prednisolone or methylprednisolone. The median (IQR) total days of exposure was 10 (5-15) days for dexamethasone and 13 (6-25) days for prednisolone or methylprednisolone. The median (IQR) cumulative dose of dexamethasone was 1.3 (0.9-2.8) mg/kg. After adjusting for potential confounders, treatment with dexamethasone for longer than 14 days was associated with worse neurodevelopmental outcomes, with mean scores in BSID-III 7.4 (95% CI, -12.3 to -2.5) points lower in the motor domain (P = .003) and 5.8 (95% CI, -10.9 to -0.6) points lower in the language domain (P = .03), compared with unexposed infants. CONCLUSIONS AND RELEVANCE These findings suggest that long duration and higher cumulative dose of dexamethasone were associated with worse neurodevelopmental scores at corrected age 2 years. Potential unmeasured differences in the clinical conditions of exposed vs unexposed infants may contribute to these findings. Improved standardization of treatment and documentation of indications would facilitate replication studies.
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Affiliation(s)
- Mihai Puia-Dumitrescu
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle
| | - Thomas R. Wood
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle
| | | | - Janessa B. Law
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle
| | - Kendell German
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle
| | - Krystle M. Perez
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle
| | - Semsa Gogcu
- Division of Neonatology, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Dennis E. Mayock
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle
| | | | - Sandra E. Juul
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle
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26
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Accorsi BF, Friedrich FO, Corso AL, Rosa JPD, Jones MH. Intra-breath oscillometry for the evaluation of lung function in children and adolescents with a history of preterm birth. J Bras Pneumol 2022; 48:e20210290. [PMID: 35137869 PMCID: PMC8836632 DOI: 10.36416/1806-3756/e20210290] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/01/2021] [Indexed: 12/04/2022] Open
Abstract
Objective: To assess respiratory system impedance (Zrs) and spirometric parameters in children and adolescents with and without a history of preterm birth. Methods: We evaluated a sample of 51 subjects between 11 and 14 years of age: 35 who had a history of preterm birth (preterm group) and 16 who had been born at term (full-term group). Lung function was measured by spirometry, spectral oscillometry, and intra-breath oscillometry. Results: Neither spirometry nor spectral oscillometry revealed any statistically significant differences between the preterm and full-term groups. However, intra-breath oscillometry demonstrated significant differences between the two groups in terms of the change in resistance, reactance at end-inspiration, and the change in reactance (p < 0.05 for all). Conclusions: Our findings suggest that abnormalities in Zrs persist in children and adolescents with a history of preterm birth and that intra-breath oscillometry is more sensitive than is spectral oscillometry. Larger studies are needed in order to validate these findings and to explore the impact that birth weight and gestational age at birth have on Zrs later in life.
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Affiliation(s)
- Bruna Freire Accorsi
- . Programa de Pós-Graduação em Pediatria e Saúde da Criança, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Frederico Orlando Friedrich
- . Programa de Pós-Graduação em Pediatria e Saúde da Criança, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Andréa Lúcia Corso
- . Departamento de Neonatologia e Pediatria, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Juliana Pontes da Rosa
- . Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS), Brasil
| | - Marcus Herbert Jones
- . Programa de Pós-Graduação em Pediatria e Saúde da Criança, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil.,. Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS), Brasil
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27
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Sindelar R, Nakanishi H, Stanford AH, Colaizy TT, Klein JM. Respiratory management for extremely premature infants born at 22 to 23 weeks of gestation in proactive centers in Sweden, Japan, and USA. Semin Perinatol 2022; 46:151540. [PMID: 34872750 DOI: 10.1016/j.semperi.2021.151540] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Survival of preterm newborn infants have increased steadily since the introduction of surfactant treatment and antenatal steroids. In the absence of randomized controlled trials on ventilatory strategies in extremely preterm infants, we present ventilatory strategies applied during the initial phase and the continued ventilatory care as applied in three centers with proactive prenatal and postnatal management and well documented good outcomes in terms of mortality and morbidity in this cohort of infants.
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Affiliation(s)
- Richard Sindelar
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Hidehiko Nakanishi
- Research and Development Center for New Medical Frontiers, Division of Neonatal Intensive Care Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Amy H Stanford
- Division of Neonatology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Tarah T Colaizy
- Division of Neonatology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Jonathan M Klein
- Division of Neonatology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
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28
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Li Y, Mo Y, Yao L, Wei Q, Meng D, Tan W, Pan X. The long-term outcomes of preterm infants receiving non-invasive high-frequency oscillatory ventilation. Front Pediatr 2022; 10:865057. [PMID: 35935354 PMCID: PMC9353142 DOI: 10.3389/fped.2022.865057] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/24/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To investigate the clinical outcomes of preterm infants who received non-invasive high-frequency oscillatory ventilation following extubation in a neonatal intensive care unit. METHODS Infants born between 25 and 34 weeks of gestation with a birth weight of <1,500 g, who were admitted into the neonatal intensive care unit of Guangxi Maternal and Child Health Hospital, Nanning, Guangxi, China, requiring mechanical ventilation on admission were randomized to the non-invasive high-frequency ventilation group, nasal intermittent positive pressure ventilation group, or nasal continuous positive airway pressure group following extubation. Their respiratory and neurodevelopmental outcomes were assessed at 12 and 24 months of corrected age. RESULTS Among 149 preterm infants who underwent randomization, 139 completed their treatment in the neonatal intensive care unit (45, 47, 47 in the non-invasive high-frequency ventilation group, nasal intermittent positive pressure ventilation group, or nasal continuous positive airway pressure group, respectively), 113 were assessed at 12-month corrected age, and 110 of 113 were assessed again at 24-month corrected age. There were no differences in the number of times bronchitis, pneumonia, wheezing episodes, and re-hospitalization rates appeared due to respiratory diseases among the three groups (P > 0.05); the pulmonary function tests at 12-month corrected age showed respiratory rate, tidal volume, inspiratory time/expiratory time, time to peak expiratory flow/expiratory time, volume at peak expiratory flow/expiratory volume, expiratory flow at 25, 50, and 75% tidal volume were all similar among infants from the 3 groups (P > 0.05). There were no differences in the rates of neurodevelopmental impairment among the three groups at 24-month corrected age (P > 0.05). CONCLUSION As post-extubation respiratory support in preterm infants, non-invasive high-frequency ventilation did not increase the rates of long-term respiratory morbidities and neurodevelopmental impairment compared with nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure.
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Affiliation(s)
- Yan Li
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.,Guangxi Clinical Research Center for Pediatric Disease, Nanning, China
| | - Yan Mo
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.,Guangxi Clinical Research Center for Pediatric Disease, Nanning, China
| | - Liping Yao
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.,Guangxi Clinical Research Center for Pediatric Disease, Nanning, China
| | - Qiufen Wei
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.,Guangxi Clinical Research Center for Pediatric Disease, Nanning, China
| | - Danhua Meng
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.,Guangxi Clinical Research Center for Pediatric Disease, Nanning, China
| | - Wei Tan
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.,Guangxi Clinical Research Center for Pediatric Disease, Nanning, China
| | - Xinnian Pan
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.,Guangxi Clinical Research Center for Pediatric Disease, Nanning, China
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29
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Middendorf L, Gellhaus A, Iannaccone A, Köninger A, Dathe AK, Bendix I, Reisch B, Felderhoff-Mueser U, Huening B. The Impact of Increased Maternal sFlt-1/PlGF Ratio on Motor Outcome of Preterm Infants. Front Endocrinol (Lausanne) 2022; 13:913514. [PMID: 35846340 PMCID: PMC9279729 DOI: 10.3389/fendo.2022.913514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The sFlt-1 (soluble fms-like tyrosine kinase-1)/PlGF (placental growth factor) ratio serves as a clinical biomarker to predict the hypertensive, placenta-derived pregnancy disorder pre-eclampsia which is often associated with placental dysfunction and fetal growth restriction. Additionally elevated levels also indicate an increased risk for prematurity. However, its predictive value for subsequent neonatal neurological outcome has not been studied. OBJECTIVE This study aimed to evaluate the correlation of maternal sFlt-1/PlGF ratio with early motor outcome of preterm infants. Design/Methods: 88 preterm infants (gestational age ≤ 34 + 0) born between February 2017 and August 2020 at the Department of Obstetrics and Gynecology, University Hospital Essen in Germany, were included, when the following variables were available: maternal sFlt-1/PlGF levels at parturition and general movement assessment of the infant at the corrected age of 3 to 5 months. The infants were stratified into high and low ratio groups according to maternal sFlt-1/PlGF cut-off values of 85. To investigate the early motor repertoire and quality of spontaneous movements of the infant, the Motor Optimality Score (MOS-R) based on antigravity movements and posture patterns, was applied. In the given age, special attention was paid to the presence of fidgety movements. Linear regressions were run to test differences in infants motor repertoire according to the maternal sFlt-1/PIGF ratio. RESULTS Linear regression analysis showed that the sFlt-1/PlGF ratio does not predict the MOS-R score (β=≤0.001; p=0.282). However, children with birth weight below the 10th percentile scored significantly lower (mean 20.7 vs 22.7; p=0.035). These children were 91% in the group with an increased ratio, which in turn is a known predictor of low birth weight (β= -0.315; p <0.001). In the group with a high sFlt-1/PLGF ratio above 85 the mothers of female infants had a lower average sFlt-1/PlGF ratio compared to a male infant (median: 438 in female vs. 603 in male infant, p=0.145). CONCLUSIONS In our cohort, especially low birth weight, which correlated with an elevated sFlt-1/PlGF ratio, had a negative effect on the outcome in the MOS-R. A direct correlation between an increased ratio and a worse motor outcome was not demonstrated.
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Affiliation(s)
- Lisa Middendorf
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Alexandra Gellhaus
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
| | - Antonella Iannaccone
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
| | - Angela Köninger
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
- Department of Obstetrics and Gynecology, University of Regensburg, Clinic St Hedwig of the Order of St. John, Regensburg, Germany
| | - Anne-Kathrin Dathe
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
- Department of Health and Nursing, Occupational Therapy, Ernst-Abbe-University of Applied Sciences, Jena, Germany
| | - Ivo Bendix
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
- Department of Pediatrics I, Neonatology and Experimental Perinatal Neurosciences, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Beatrix Reisch
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
| | - Ursula Felderhoff-Mueser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Britta Huening
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
- *Correspondence: Britta Huening,
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Definitions of bronchopulmonary dysplasia and long-term outcomes of extremely preterm infants in Korean Neonatal Network. Sci Rep 2021; 11:24349. [PMID: 34934085 PMCID: PMC8692520 DOI: 10.1038/s41598-021-03644-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/25/2021] [Indexed: 12/01/2022] Open
Abstract
New definitions for bronchopulmonary dysplasia (BPD) have recently been suggested, and an accurate diagnosis, including severity classification with proper definition, is crucial to identify high-risk infants for appropriate interventions. To determine whether recently suggested BPD definitions can better predict long-term outcomes of BPD in extremely preterm infants (EPIs) than the original BPD definition, BPD was classified with severity 1, 2, and 3 using three different definitions: definition A (original), National Institute of Child Health and Human Development (NICHD) definition in 2001; definition B, the modified NICHD 2016 definition (graded by the oxygen concentration and the respiratory support at 36 weeks’ postmenstrual age [PMA]); and definition C, the modified Jensen 2019 definition (graded by the respiratory support at 36 weeks’ PMA). We evaluated 1050 EPIs using a national cohort. Whereas EPIs with grade 2 or 3 BPD as per definition A did not show any increase in the risk, EPIs with BPD diagnosed by definition B and C showed significantly increased risk for poor outcomes, such as respiratory mortality and morbidities, neurodevelopmental delay, and growth restriction at 18–24 months of corrected age. The recently suggested definition and severity grading better reflects long-term childhood morbidities than the original definition in EPIs.
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Owen LS, Manley BJ, Hodgson KA, Roberts CT. Impact of early respiratory care for extremely preterm infants. Semin Perinatol 2021; 45:151478. [PMID: 34474939 DOI: 10.1016/j.semperi.2021.151478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Despite advances in neonatal intensive care, more than half of surviving infants born extremely preterm (EP; < 28 weeks' gestation) develop bronchopulmonary dysplasia (BPD). Prevention of BPD is critical because of its associated mortality and morbidity, including adverse neurodevelopmental outcomes and respiratory health in later childhood and beyond. The respiratory care of EP infants begins before birth, then continues in the delivery room and throughout the primary hospitalization. This chapter will review the evidence for interventions after birth that might improve outcomes for infants born EP, including the timing of umbilical cord clamping, strategies to avoid or minimize exposure to mechanical ventilation, modes of mechanical ventilation and non-invasive respiratory support, oxygen saturation targets, postnatal corticosteroids and other adjunct therapies.
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Affiliation(s)
- Louise S Owen
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; Newborn Research Centre, The Royal Women's Hospital, Flemington Road, Parkville, Melbourne, VIC 3052, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Brett J Manley
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; Newborn Research Centre, The Royal Women's Hospital, Flemington Road, Parkville, Melbourne, VIC 3052, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Kate A Hodgson
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; Newborn Research Centre, The Royal Women's Hospital, Flemington Road, Parkville, Melbourne, VIC 3052, Australia
| | - Calum T Roberts
- Monash Newborn, Monash Children's Hospital, Monash University, Clayton, VIC, Australia; Department of Paediatrics, Monash University, Clayton, VIC, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia
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Saengrat P, Limrungsikul A. Predictive Ability of the New Bronchopulmonary Dysplasia Definition on Pulmonary Outcomes at 20 to 24 months' Corrected Age of Preterm Infants. Am J Perinatol 2021. [PMID: 34492722 DOI: 10.1055/s-0041-1735219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to determine the predictive abilities of the National Institute of Child Health and Human Development (NICHD) 2018 definition of bronchopulmonary dysplasia (BPD) on mortality and pulmonary outcomes of preterm infants at 20 to 24 months' corrected age and compare them with the National Institutes of Health (NIH) 2001 definition. STUDY DESIGN A retrospective cohort study was conducted in a level III neonatal intensive care unit (NICU) in Bangkok, Thailand. Data from 502 infants less than 32 weeks of gestation born between 2011 and 2017 were reviewed. Follow-up data were available in 460 infants (91.6%). BPD severity was graded according to the NICHD 2018 and the NIH 2001 definitions. Infants' mortality and pulmonary outcomes were compared between these two definitions. RESULTS The prevalence of BPD by the NIH 2001 and NICHD 2018 definition were 52.4 and 23.9%, respectively. Using the NIH 2001 definition, the severity of BPD could not be classified in 4.2% of the infants. Progressive severity of BPD by the NICHD 2018 definition was associated with higher incidence of pulmonary morbidities. By using area under the curve (AUC), the accuracy of NICHD 2018 definition in predicting death due to respiratory diseases and home oxygen therapy were significantly higher than those using NIH 2001 definition (0.884 vs. 0.740 [p <0.001] and 0.893 vs. 0.746 [p <0.001], respectively). CONCLUSION The NICHD 2018 definition of BPD categorized fewer preterm infants with BPD in our cohort of preterm infants. This current definition has better predictive ability on mortality and pulmonary morbidities than the NIH 2001 definition. KEY POINTS · The NICHD 2018 BPD definition has not been validated for predicting long-term pulmonary outcomes.. · The NICHD 2018 definition categorized fewer preterm infants with BPD in our cohort of preterm.. · The NICHD 2018 definition adequately predicted mortality and morbidities of preterm infants..
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Affiliation(s)
- Pichada Saengrat
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Anchalee Limrungsikul
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Ramaswamy VV, Bandyopadhyay T, Nanda D, Bandiya P, Ahmed J, Garg A, Roehr CC, Nangia S. Assessment of Postnatal Corticosteroids for the Prevention of Bronchopulmonary Dysplasia in Preterm Neonates: A Systematic Review and Network Meta-analysis. JAMA Pediatr 2021; 175:e206826. [PMID: 33720274 PMCID: PMC7961472 DOI: 10.1001/jamapediatrics.2020.6826] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
IMPORTANCE The safety of postnatal corticosteroids used for prevention of bronchopulmonary dysplasia (BPD) in preterm neonates is a controversial matter, and a risk-benefit balance needs to be struck. OBJECTIVE To evaluate 14 corticosteroid regimens used to prevent BPD: moderately early-initiated, low cumulative dose of systemic dexamethasone (MoLdDX); moderately early-initiated, medium cumulative dose of systemic dexamethasone (MoMdDX); moderately early-initiated, high cumulative dose of systemic dexamethasone (MoHdDX); late-initiated, low cumulative dose of systemic dexamethasone (LaLdDX); late-initiated, medium cumulative dose of systemic dexamethasone (LaMdDX); late-initiated, high cumulative dose of systemic dexamethasone (LaHdDX); early-initiated systemic hydrocortisone (EHC); late-initiated systemic hydrocortisone (LHC); early-initiated inhaled budesonide (EIBUD); early-initiated inhaled beclomethasone (EIBEC); early-initiated inhaled fluticasone (EIFLUT); late-initiated inhaled budesonide (LIBUD); late-initiated inhaled beclomethasone (LIBEC); and intratracheal budesonide (ITBUD). DATA SOURCES PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, World Health Organization's International Clinical Trials Registry Platform (ICTRP), and CINAHL were searched from inception through August 25, 2020. STUDY SELECTION In this systematic review and network meta-analysis, the randomized clinical trials selected included preterm neonates with a gestational age of 32 weeks or younger and for whom a corticosteroid regimen was initiated within 4 weeks of postnatal age. Peer-reviewed articles and abstracts in all languages were included. DATA EXTRACTION AND SYNTHESIS Two independent authors extracted data in duplicate. Network meta-analysis used a bayesian model. MAIN OUTCOMES AND MEASURES Primary combined outcome was BPD, defined as oxygen requirement at 36 weeks' postmenstrual age (PMA), or mortality at 36 weeks' PMA. The secondary outcomes included 15 safety outcomes. RESULTS A total of 62 studies involving 5559 neonates (mean [SD] gestational age, 26 [1] weeks) were included. Several regimens were associated with a decreased risk of BPD or mortality, including EHC (risk ratio [RR], 0.82; 95% credible interval [CrI], 0.68-0.97); EIFLUT (RR, 0.75; 95% CrI, 0.55-0.98); LaHdDX (RR, 0.70; 95% CrI, 0.54-0.87); MoHdDX (RR, 0.64; 95% CrI, 0.48-0.82); ITBUD (RR, 0.73; 95% CrI, 0.57-0.91); and MoMdDX (RR, 0.61; 95% CrI, 0.45-0.79). Surface under the cumulative ranking curve (SUCRA) value ranking showed that MoMdDX (SUCRA, 0.91), MoHdDX (SUCRA, 0.86), and LaHdDX (SUCRA, 0.76) were the 3 most beneficial interventions. ITBUD (RR, 4.36; 95% CrI, 1.04-12.90); LaHdDX (RR, 11.91; 95% CrI, 1.64-44.49); LaLdDX (RR, 6.33; 95% CrI, 1.62-18.56); MoHdDX (RR, 4.96; 95% CrI, 1.14-14.75); and MoMdDX (RR, 3.16; 95% CrI, 1.35-6.82) were associated with more successful extubation from invasive mechanical ventilation. EHC was associated with a higher risk of gastrointestinal perforation (RR, 2.77; 95% CrI, 1.09-9.32). MoMdDX showed a higher risk of hypertension (RR, 3.96; 95% CrI, 1.10-30.91). MoHdDX had a higher risk of hypertrophic cardiomyopathy (RR, 5.94; 95% CrI, 1.95-18.11). CONCLUSIONS AND RELEVANCE This study suggested that MoMdDX may be the most appropriate postnatal corticosteroid regimen for preventing BPD or mortality at a PMA of 36 weeks, albeit with a risk of hypertension. The quality of evidence was low.
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Affiliation(s)
- Viraraghavan Vadakkencherry Ramaswamy
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom,Ankura Hospital for Women and Children, Hyderabad, India
| | - Tapas Bandyopadhyay
- Department of Neonatology, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Debasish Nanda
- Department of Neonatology, Institute of Medical Sciences and SUM Hospital, Orissa, India
| | - Prathik Bandiya
- Department of Neonatology, Indira Gandhi Institute of Child Health, Bengaluru, India
| | - Javed Ahmed
- Women’s Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar
| | - Anip Garg
- Department of Neonatology, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Charles C. Roehr
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom,National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Sushma Nangia
- Department of Neonatology, Lady Hardinge Medical College, New Delhi, India
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Liviskie C, Vesoulis Z, Zeller B, Rao R, McPherson C. Respiratory effects of prolonged prednisolone use in infants with evolving and established Bronchopulmonary dysplasia. Early Hum Dev 2021; 156:105344. [PMID: 33684601 DOI: 10.1016/j.earlhumdev.2021.105344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/12/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Current literature focuses on systemic corticosteroids for prevention of bronchopulmonary dysplasia (BPD) in preterm infants with limited data on use for pulmonary disease after the first month of life. Prednisolone may be a reasonable option for late treatment given its desirable pharmacologic properties and use in other pediatric disease states. AIMS To characterize a premature population that received an extended prednisolone course and determine the effect on respiratory and anthropometric outcomes over time. STUDY DESIGN Single-center, retrospective study. SUBJECTS Preterm infants who received ≥30 days of prednisolone or methylprednisolone for treatment of respiratory complications following preterm birth. OUTCOMES MEASURES Assessment of pulmonary severity score (PSS), weight, length, and occipital frontal circumference weekly during the first 4 weeks of prednisolone and after discontinuation. RESULTS Thirty-four infants with a mean gestational age of 26.5 ± 2.5 weeks and birth weight of 846 ± 353 g were identified. Nine patients were on invasive mechanical ventilation and 25 patients were on non-invasive respiratory support at prednisolone initiation. Prednisolone was initiated at a mean post-menstrual age of 41.7 ± 5 weeks and a mean dose of 1.7 ± 0.6 mg/kg/day. A significant decrease in PSS was seen over time (p < 0.001) without rebound following discontinuation. Eleven patients decreased the mode of respiratory support during prednisolone treatment. No significant impact in anthropometric outcomes were identified. CONCLUSION Prolonged prednisolone use was associated with a sustained decrease in PSS without adverse effects on growth measurements. These results suggest potential benefit of prednisolone on respiratory outcomes in a subset of preterm infants.
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Affiliation(s)
- Caren Liviskie
- Department of Pharmacy, St. Louis Children's Hospital, One Children's Place, St. Louis, MO 63110, USA.
| | - Zachary Vesoulis
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110, USA.
| | - Brandy Zeller
- Department of Pharmacy, St. Louis Children's Hospital, One Children's Place, St. Louis, MO 63110, USA.
| | - Rakesh Rao
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110, USA.
| | - Christopher McPherson
- Department of Pharmacy, St. Louis Children's Hospital, One Children's Place, St. Louis, MO 63110, USA; Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110, USA.
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Pérez-Pereira M. Prevalence of Language Delay among Healthy Preterm Children, Language Outcomes and Predictive Factors. CHILDREN-BASEL 2021; 8:children8040282. [PMID: 33917554 PMCID: PMC8067481 DOI: 10.3390/children8040282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/12/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022]
Abstract
Language delay (LD) and its relationship with later language impairment in preterm children is a topic of major concern. Previous studies comparing LD in preterm (PT) and full-term (FT) children were mainly carried out with samples of extremely preterm and very preterm children (sometimes with additional medical problems). Very few of them were longitudinal studies, which is essential to understand developmental relationships between LD and later language impairment. In this study, we compare the prevalence of LD in low-risk preterm children to that of FT children in a longitudinal design ranging from 10 to 60 months of age. We also analyze which variables are related to a higher risk of LD at 22, 30 and 60 months of age. Different language tests were administered to three groups of preterm children of different gestational ages and to one group of full-term children from the ages of 10 to 60 months. ANOVA comparisons between groups and logistic regression analyses to identify possible predictors of language delay at 22, 30 and 60 months of age were performed. The results found indicate that there were practically no differences between gestational age groups. Healthy PT children, therefore, do not have, in general terms, a higher risk of language delay than FT children. Previous language delay and cognitive delay are the strongest and longest-lasting predictors of later language impairment. Other factors, such as a scarce use of gestures at 10 months or male gender, affect early LD at 22 months of age, although their effect disappears as children grow older. Low maternal education appears to have a late effect. Gestational age does not have any significant effect on the appearance of LD.
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Affiliation(s)
- Miguel Pérez-Pereira
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Santiago de Compostela, 15705 Santiago de Compostela, Spain
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Sullivan KP, White HO, Grover LE, Negron JJ, Lee AF, Rhein LM. Transcutaneous carbon dioxide pattern and trend over time in preterm infants. Pediatr Res 2021; 90:840-846. [PMID: 33469188 PMCID: PMC7814526 DOI: 10.1038/s41390-020-01308-2] [Citation(s) in RCA: 1] [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: 02/21/2020] [Revised: 10/08/2020] [Accepted: 10/29/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Chronic lung disease remains a burden for extremely preterm infants. The changes in ventilation over time and optimal ventilatory management remains unknown. Newer, non-invasive technologies provide insight into these patterns. METHODS This single-center prospective cohort study enrolled infants ≤32 0/7 weeks. We obtained epochs of transcutaneous carbon dioxide (TcCO2) measurements twice each week to describe the pattern of hypercarbia throughout their hospitalization. RESULTS Patterns of hypercarbia varied based on birth gestational age and post-menstrual age (PMA) (p = 0.03), regardless of respiratory support. Infants receiving the most respiratory support had values 16-21 mmHg higher than those on room air (p < 0.001). Infants born at the youngest gestational ages had the greatest total change but the rate of change was slower (p = 0.049) compared to infants born at later gestational ages. All infants had TcCO2 values stabilize by 31-33 weeks PMA, when values were not significantly different compared to discharge. No rebound was observed when infants weaned off invasive support. CONCLUSIONS Hypercarbia improves as infants approached 31-33 weeks PMA. Hypercarbia was the highest in the most immature infants and improved with age and growth despite weaning respiratory support. IMPACT This study describes the evolution of hypercarbia as very preterm infants grow and develop. The pattern of ventilation is significantly different depending on the gestational age at birth and post-menstrual age. Average transcutaneous carbon dioxide (TCO2) decreased over time as infants became more mature despite weaning respiratory support. This improvement was most significant in infants born at the lowest gestational ages.
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Affiliation(s)
- Katherine P. Sullivan
- grid.168645.80000 0001 0742 0364Department of Neonatology, University of Massachusetts Medical School, Worcester, MA USA
| | - Heather O. White
- grid.168645.80000 0001 0742 0364Department of Neonatology, University of Massachusetts Medical School, Worcester, MA USA
| | - Lindsay E. Grover
- grid.168645.80000 0001 0742 0364Department of Neonatology, University of Massachusetts Medical School, Worcester, MA USA
| | - Jordi J. Negron
- grid.168645.80000 0001 0742 0364Department of Neonatology, University of Massachusetts Medical School, Worcester, MA USA
| | - Austin F. Lee
- grid.168645.80000 0001 0742 0364Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA USA ,grid.32224.350000 0004 0386 9924Department of Surgery, Massachusetts General Hospital, Worcester, MA USA
| | - Lawrence M. Rhein
- grid.168645.80000 0001 0742 0364Department of Neonatology, University of Massachusetts Medical School, Worcester, MA USA ,grid.168645.80000 0001 0742 0364Department of Pediatric Pulmonary Medicine, University of Massachusetts Medical School, Worcester, MA USA
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A multidisciplinary chronic lung disease team in a neonatal intensive care unit is associated with increased survival to discharge of infants with tracheostomy. J Perinatol 2021; 41:1963-1971. [PMID: 33795789 PMCID: PMC8013205 DOI: 10.1038/s41372-021-00974-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/20/2020] [Accepted: 01/27/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To determine if multidisciplinary team-based care of severe BPD/CLD infants improve survival to discharge. DESIGN/METHODS Retrospective review of severe BPD/CLD infants cared for by dedicated multidisciplinary CLD team using consensus-driven protocols and guidelines. RESULTS Total of 267 patients. Median gestational age was 26 weeks (IQR 24, 32); median birth-weight was 0.85 (IQR 0.64, 1.5). Twenty-four percent were preterm with severe BPD, 46% had other primary respiratory diseases (none BPD diseases). Total number of patients, proportion of patients with tracheostomy, prematurity, and genetic diagnoses increased over time. 88.8% survived to discharge. Unadjusted logistic regression showed that tracheostomy was not associated with odds of death; secondary pulmonary hypertension was associated with odds of tracheostomy (OR = 1.795 p value = 0.0264), or death (OR = 8.587 p value = <0.0001), or tracheostomy + death (OR = 13.58 p value = 0.0007). CONCLUSIONS Over time, mortality improved for infants with tracheostomy cared for by a multidisciplinary severe BPD/CLD team. Secondary pulmonary hypertension was associated with tracheostomy, or death, or tracheostomy + death.
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Dawson SK, D'Andrea LA, Lau R, Lagatta JM. Using a home oxygen weaning protocol and pCO 2 to evaluate outcomes for infants with bronchopulmonary dysplasia discharged on home oxygen. Pediatr Pulmonol 2020; 55:3293-3303. [PMID: 32897654 PMCID: PMC7658043 DOI: 10.1002/ppul.25057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/12/2020] [Accepted: 09/02/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Predischarge capillary blood gas partial pressure of carbon dioxide (pCO2 ) has been associated with increased adverse events including readmission. This study aimed to determine if predischarge pCO2 or 36-week pCO2 was associated with increased respiratory readmissions or other pulmonary healthcare utilization in the year after neonatal intensive care unit (NICU) discharge for infants with bronchopulmonary dysplasia (BPD) discharged with home oxygen, using a standardized outpatient oxygen weaning protocol. METHODS This was a secondary cohort analysis of infants born <32 weeks gestational age with BPD, referred to our clinic for home oxygen therapy from either from our level IV NICU or local level III NICUs between 2015 and 2017. Infants with major nonrespiratory comorbidities were excluded. Subject information was obtained from electronic health records. RESULTS Of 125 infants, 120 had complete 1-year follow-up. Twenty-three percent of infants experienced a respiratory readmission after NICU discharge. There was no significant association between predischarge or 36-week pCO2 and respiratory readmissions, emergency room visits, new or increased bronchodilators, or diuretics. Higher 36-week pCO2 was associated with a later corrected age when oxygen was discontinued (<6 months; median, 54 mmHg; interquartile range [IQR], 51-61; 6-11 months; median, 62 mmHg; IQR, 57-65; ≥12 months, median, 66 mmHg; IQR, 58-73; p = .006). CONCLUSIONS Neither predischarge pCO2 nor 36-week pCO2 was associated with 1-year respiratory readmissions. However higher pCO2 at 36 weeks was associated with a longer duration of home oxygen. Neonatal illness measures like 36-week pCO2 may be useful in communicating expectations for home oxygen therapy to families.
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Affiliation(s)
- Sara K Dawson
- Department of Pediatrics, Divisions of Pulmonary and Sleep Medicine, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Lynn A D'Andrea
- Department of Pediatrics, Divisions of Pulmonary and Sleep Medicine, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Ryan Lau
- Department of Pediatrics, Division of Neonatology, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Joanne M Lagatta
- Department of Pediatrics, Division of Neonatology, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, Wisconsin, USA
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Automated brain MRI metrics in the EPIRMEX cohort of preterm newborns: Correlation with the neurodevelopmental outcome at 2 years. Diagn Interv Imaging 2020; 102:225-232. [PMID: 33187906 DOI: 10.1016/j.diii.2020.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/30/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this study was to identify in the EPIRMEX cohort the correlations between MRI brain metrics, including diffuse excessive high signal intensities (DEHSI) obtained with an automated quantitative method and neurodevelopmental outcomes at 2 years. MATERIALS AND METHODS A total of 390 very preterm infants (gestational age at birth≤32 weeks) who underwent brain MRI at term equivalent age at 1.5T (n=338) or 3T (n=52) were prospectively included. Using a validated algorithm, automated metrics of the main brain surfaces (cortical and deep gray matter, white matter, cerebrospinal fluid) and DEHSI with three thresholds were obtained. Linear adjust regressions were performed to assess the correlation between brain metrics with the ages and stages questionnaire (ASQ) score at 2 years. RESULTS Basal ganglia and thalami, cortex and white matter surfaces positively and significantly correlated with the global ASQ score. For all ASQ sub-domains, basal ganglia and thalami surfaces significantly correlated with the scores. DEHSI was present in 289 premature newborns (74%) without any correlation with the ASQ score. Metrics of DEHSI were greater at 3T than at 1.5T. CONCLUSION Brain MRI metrics obtained in our multicentric cohort correlate with the neurodevelopmental outcome at 2 years of age. The quantitative detection of DEHSI is not predictive of adverse outcomes. Our automated algorithm might easily provide useful predictive information in daily practice.
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Mechanical Ventilation Duration, Brainstem Development, and Neurodevelopment in Children Born Preterm: A Prospective Cohort Study. J Pediatr 2020; 226:87-95.e3. [PMID: 32454115 DOI: 10.1016/j.jpeds.2020.05.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/22/2020] [Accepted: 05/18/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To determine, in children born preterm, the association of mechanical ventilation duration with brainstem development, white matter maturation, and neurodevelopmental outcomes at preschool age. STUDY DESIGN This prospective cohort study included 144 neonates born at <30 weeks of gestation (75 male, mean gestational age 27.1 weeks, SD 1.6) with regional brainstem volumes automatically segmented on magnetic resonance imaging at term-equivalent age (TEA). The white matter maturation was assessed by diffusion tensor imaging and tract-based spatial statistics. Neurodevelopmental outcomes were assessed at 4.5 years of age using the Movement Assessment Battery for Children, 2nd Edition, and the Wechsler Primary and Preschool Scale of Intelligence, 4th Edition, full-scale IQ. The association between the duration of mechanical ventilation and brainstem development was validated in an independent cohort of children born very preterm. RESULTS Each additional day of mechanical ventilation predicted lower motor scores (0.5-point decrease in the Movement Assessment Battery for Children, 2nd Edition, score by day of mechanical ventilation, 95% CI -0.6 to -0.3, P < .0001). Prolonged exposure to mechanical ventilation was associated with smaller pons and medulla volumes at TEA in 2 independent cohorts, along with widespread abnormalities in white matter maturation. Pons and medulla volumes at TEA predicted motor outcomes at 4.5 years of age. CONCLUSIONS In neonates born very preterm, prolonged mechanical ventilation is associated with impaired brainstem development, abnormal white matter maturation, and lower motor scores at preschool age. Further research is needed to better understand the neural pathological mechanisms involved.
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Ha AW, Sudhadevi T, Ebenezer DL, Fu P, Berdyshev EV, Ackerman SJ, Natarajan V, Harijith A. Neonatal therapy with PF543, a sphingosine kinase 1 inhibitor, ameliorates hyperoxia-induced airway remodeling in a murine model of bronchopulmonary dysplasia. Am J Physiol Lung Cell Mol Physiol 2020; 319:L497-L512. [PMID: 32697651 DOI: 10.1152/ajplung.00169.2020] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Hyperoxia (HO)-induced lung injury contributes to bronchopulmonary dysplasia (BPD) in preterm newborns. Intractable wheezing seen in BPD survivors is associated with airway remodeling (AWRM). Sphingosine kinase 1 (SPHK1)/sphingosine-1-phosphate (S1P) signaling promotes HO-mediated neonatal BPD; however, its role in the sequela of AWRM is not known. We noted an increased concentration of S1P in tracheal aspirates of neonatal infants with severe BPD, and earlier, demonstrated that Sphk1-/- mice showed protection against HO-induced BPD. The role of SPHK1/S1P in promoting AWRM following exposure of neonates to HO was investigated in a murine model. Therapy using PF543, the specific SPHK1 inhibitor, during neonatal HO reduced alveolar simplification followed by reduced AWRM in adult mice. This was associated with reduced airway hyperreactivity to intravenous methacholine. Neonatal HO exposure was associated with increased expression of SPHK1 in lung tissue of adult mice, which was reduced with PF543 therapy in the neonatal stage. This was accompanied by amelioration of HO-induced reduction of E-cadherin in airway epithelium. This may be suggestive of arrested partial epithelial mesenchymal transition (EMT) induced by HO. In vitro studies using human primary airway epithelial cells (HAEpCs) showed that SPHK1 inhibition or deletion restored HO-induced reduction in E-cadherin and reduced formation of mitochondrial reactive oxygen species (mtROS). Blocking mtROS with MitoTempo attenuated HO-induced partial EMT of HAEpCs. These results collectively support a therapeutic role for PF543 in preventing HO-induced BPD in neonates and the long-term sequela of AWRM, thus conferring a long-term protection resulting in improved lung development and function.
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Affiliation(s)
- Alison W Ha
- Department of Biochemistry, University of Illinois, Chicago, Illinois
| | - Tara Sudhadevi
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
| | - David L Ebenezer
- Department of Pharmacology, University of Illinois, Chicago, Illinois
| | - Panfeng Fu
- Department of Pharmacology, University of Illinois, Chicago, Illinois
| | | | - Steven J Ackerman
- Department of Biochemistry, University of Illinois, Chicago, Illinois
| | - Viswanathan Natarajan
- Department of Pharmacology, University of Illinois, Chicago, Illinois.,Department of Medicine, University of Illinois, Chicago, Illinois
| | - Anantha Harijith
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
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Roberts CT, Owen LS, Frøisland DH, Doyle LW, Davis PG, Manley BJ. Predictors and Outcomes of Early Intubation in Infants Born at 28-36 Weeks of Gestation Receiving Noninvasive Respiratory Support. J Pediatr 2020; 216:109-116.e1. [PMID: 31610936 DOI: 10.1016/j.jpeds.2019.09.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/02/2019] [Accepted: 09/11/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To identify predictors and outcomes of early intubation in preterm infants with respiratory distress, and predictors of need for brief respiratory support (≤1 day). STUDY DESIGN Secondary analysis of data from a randomized trial comparing nasal high-flow with continuous positive airway pressure as primary respiratory support in preterm infants born at 28-36 weeks of gestation. Intubation was assessed within 72 hours of randomization. RESULTS There were 564 included infants with a mean (SD) gestational age of 32.0 (2.2) weeks and birth weight 1744 (589) g; 76 infants (13.5%) received early intubation. On multivariable analysis, lower gestational age and higher pre-randomization fraction of inspired oxygen (FiO2) predicted intubation. A test based on gestational age of <30 weeks and an FiO2 of ≥0.30 produced a likelihood ratio of 9.1. Intubation was associated with prolonged duration of respiratory support and supplemental oxygen, with pneumothorax and nasal trauma, and in infants born at <32 weeks of gestational, with bronchopulmonary dysplasia and patent ductus arteriosus requiring treatment. Greater gestational age and lower FiO2 predicted the need for ≤1 day of respiratory support. A test based on a gestational age of ≥34 weeks and an FiO2 of 0.21 produced a likelihood ratio of 4.7. CONCLUSIONS In preterm infants 28-36 week of gestation receiving primary noninvasive respiratory support, lower gestational age, and higher FiO2 predicted need for intubation within 72 hours. Intubation was associated with adverse respiratory outcomes. Greater gestational age and lower FiO2 predicted need for ≤1 day of respiratory support. It may be reasonable to defer the use of respiratory support in more mature infants with low FiO2 requirements. TRIAL REGISTRATION AUSTRALIAN NEW ZEALAND CLINICAL TRIALS REGISTRY: ACTRN12613000303741.
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Affiliation(s)
- Calum T Roberts
- Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia; Department of Pediatrics, Monash University, Melbourne, Victoria, Australia; Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia.
| | - Louise S Owen
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia; Department of Obstetrics and Gynecology, The University of Melbourne, Melbourne, Victoria, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Dag H Frøisland
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia; Department of Pediatrics, Innlandet Hospital Trust, Lillehammer, Norway
| | - Lex W Doyle
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia; Department of Obstetrics and Gynecology, The University of Melbourne, Melbourne, Victoria, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Pediatrics, The University of Melbourne, Melbourne, Australia
| | - Peter G Davis
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia; Department of Obstetrics and Gynecology, The University of Melbourne, Melbourne, Victoria, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Brett J Manley
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia; Department of Obstetrics and Gynecology, The University of Melbourne, Melbourne, Victoria, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Ding L, Wang H, Geng H, Cui N, Huang F, Zhu X, Zhu X. Prediction of Bronchopulmonary Dysplasia in Preterm Infants Using Postnatal Risk Factors. Front Pediatr 2020; 8:349. [PMID: 32676490 PMCID: PMC7333538 DOI: 10.3389/fped.2020.00349] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/26/2020] [Indexed: 01/12/2023] Open
Abstract
Objective: To identify postnatal risk factors for bronchopulmonary dysplasia (BPD) development in preterm infants with gestational age ≤32 weeks. Methods: Seventy-two preterm infants(30 with BPD and 42 non-BPD controls) admitted in the neonatal intensive care unit (NICU) of the Children's Hospital of Soochow University during 2017 were enrolled in this prospective longitudinal study. Perinatal clinical data, a neonatal critical illness score (NCIS), different soluble B7-H3(sB7-H3), and interleukin-18 (IL-18) levels by days after birth were collected. An early predictive model for BPD development was established based on clinical data using multiple logistic regression analysis. And the sensitivity and specificity of the model were assesed by ROC curve. Results: Electrolyte disturbances, hemodynamically significant patent ductus arteriosus (hs-PDA), and the age that infants achieved 120 kcal/kg.d via enteral feeding ≥40 days after birth were found to be associated with the BPD pathogenesis. Serum sB7-H3, IL-18, and NCIS were significantly higher in the BPD group compared to the non-BPD group (p < 0.05). BPD group had significantly lower enteral fluid and caloric intake compared to the non-BPD group at 1, 7, 14, and 28 days after birth. The risk factors were analyzed by multiple logistic regression and a predictive model of a combination of sB7-H3 (day 7), IL-18 (day 14), NCIS, and clinical risk factors was evaluated via ROC curve with an area under the curve (AUC) of 0.960 having sensitivity of 86.7% and a specificity of 97.6%, respectively. Conclusion: The causes of BPD are multifactorial postnatal risk factors. And the combination of sB7-H3 (day 7), IL-18 (day 14), NCIS, and clinical risk factors (electrolyte disturbances, hs-PDA, and the age that infants achieved 120 kcal/kg.d via enteral feeding ≥40 days after birth) might be served as an optimal predictive model for the occurrence of BPD.
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Affiliation(s)
- Li Ding
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, China
| | - Huawei Wang
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, China
| | - Haifeng Geng
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, China
| | - Ningxun Cui
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, China
| | - Fengxia Huang
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, China
| | - Xueping Zhu
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, China
| | - Xiaoli Zhu
- Department of Intervention, The First Affiliated Hospital of Soochow University, Suzhou, China
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Bapat R, Nelin L, Shepherd E, Ryshen G, Elgin A, Bartman T. A multidisciplinary quality improvement effort to reduce bronchopulmonary dysplasia incidence. J Perinatol 2020; 40:681-687. [PMID: 31907398 PMCID: PMC7223819 DOI: 10.1038/s41372-019-0574-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/03/2019] [Accepted: 12/18/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Bronchopulmonary Dysplasia (BPD) is the most common prematurity complication. Although several practices have been proposed for BPD prevention, none of these in isolation prevent BPD. METHODS Our initiative focused on two key drivers: oxygen management and noninvasive ventilation strategies. We created best practice guidelines and followed outcome measures using Shewhart control charts. RESULTS PDSAs of protocols preceded a large-scale rollout of a "0.21 by 28" campaign in 2014 leading to a special cause reduction in the "any BPD" rate, and a decrease in severe BPD (from 57 to 29%). At the end of 2017, we reinvigorated the project, which led to dramatic decreases in the "any BPD" rate to 41% and the "severe BPD" rate to 21%. CONCLUSIONS A multidisciplinary QI initiative focused on process improvement geared towards the pathophysiological contributors of BPD has successfully reduced the rate of BPD in an all referral level IV NICU.
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Affiliation(s)
- Roopali Bapat
- 0000 0004 0392 3476grid.240344.5Division of Neonatology, Nationwide Children’s Hospital, Columbus, OH USA
| | - Leif Nelin
- 0000 0004 0392 3476grid.240344.5Division of Neonatology, Nationwide Children’s Hospital, Columbus, OH USA ,0000 0004 0392 3476grid.240344.5Research Institute and Center for Perinatal Research, Nationwide Children’s Hospital, Columbus, OH USA
| | - Edward Shepherd
- 0000 0004 0392 3476grid.240344.5Division of Neonatology, Nationwide Children’s Hospital, Columbus, OH USA
| | - Greg Ryshen
- 0000 0004 0392 3476grid.240344.5Nationwide Children’s Hospital, Columbus, OH USA
| | - Amee Elgin
- 0000 0004 0392 3476grid.240344.5Nationwide Children’s Hospital, Columbus, OH USA
| | - Thomas Bartman
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, USA.
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Current insights in non-invasive ventilation for the treatment of neonatal respiratory disease. Ital J Pediatr 2019; 45:105. [PMID: 31426828 PMCID: PMC6700989 DOI: 10.1186/s13052-019-0707-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 08/13/2019] [Indexed: 11/10/2022] Open
Abstract
Deleterious consequences of the management of respiratory distress syndrome (RDS) with invasive ventilation have led to more in-depth investigation of non-invasive ventilation (NIV) modalities. NIV has significantly and positively altered the treatment outcomes and improved mortality rates of preterm infants with RDS. Among the different NIV modes, nasal intermittent positive pressure ventilation (NIPPV) has shown considerable benefits compared to nasal continuous positive airway pressure (NCPAP). Despite reports of heated humidified high-flow nasal cannula’s (HHHFNC) non-inferiority compared to NCPAP, some trials have been terminated due to high treatment failure rates with HHHFNC use. Moreover, RDS management with the combination of INSURE (INtubation SURfactant Extubation) technique and NIV ensures higher success rates. This review elaborates on the currently used various modes of NIV and novel techniques are also briefly discussed.
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Guillot M, Asad S, Lalu MM, Lemyre B, Castillo G, Thébaud B, Presseau J. So You Want to Give Stem Cells to Babies? Neonatologists and Parents' Views to Optimize Clinical Trials. J Pediatr 2019; 210:41-47.e1. [PMID: 31005276 DOI: 10.1016/j.jpeds.2019.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/22/2019] [Accepted: 03/08/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To identify barriers and enablers that may influence parents' and neonatologists' participation in clinical trials of mesenchymal stromal cells for bronchopulmonary dysplasia. STUDY DESIGN This qualitative study involved one-on-one semistructured interviews with parents of extremely preterm infants (n = 18) and neonatologists (n = 16). Interview guides and directed content analysis were framed using the theoretical domains framework, a tool specifically developed for implementation research to identify influences on behavior. RESULTS Key barriers for parents included their lack of knowledge about clinical trial processes in general, stem cells, and concerns about their risks and side effects. Importantly, parents preferred to be approached for recruitment directly by a neonatologist, either before delivery or 1 or 2 weeks after birth. However, the majority of neonatologists felt that approaching parents was not part of their role. Neonatologists reported competing priorities, time commitment, costs, and lack of institutional support as significant barriers to their ability to recruit patients. CONCLUSIONS By integrating stakeholders early into the development of a clinical trial of mesenchymal stromal cell therapy, we identified and can address important barriers to enrollment. Some identified barriers were unanticipated and could have compromised recruitment had they not been identified by this study. We suggest that this approach can be used more broadly for other early phase clinical trials in pediatrics.
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Affiliation(s)
- Mireille Guillot
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Eastern Ontario and The Ottawa Hospital, Ottawa, Ontario, Canada.
| | - Sarah Asad
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Manoj M Lalu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Brigitte Lemyre
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Eastern Ontario and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Gisell Castillo
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Bernard Thébaud
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Eastern Ontario and The Ottawa Hospital, Ottawa, Ontario, Canada; Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada; Molecular Biomedicine, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Piris Borregas S, Torres Valdivieso MJ, Martín‐Arriscado C, Cruz Bértolo J, Sierra García P, Pallás Alonso CR. Model that predicted death or disabilities in premature infants was valid at seven years of age. Acta Paediatr 2019; 108:1245-1249. [PMID: 30536707 DOI: 10.1111/apa.14679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/07/2018] [Accepted: 12/03/2018] [Indexed: 11/30/2022]
Abstract
AIM Validated a model that used bronchopulmonary dysplasia (BPD), brain injuries measured using ultrasound and retinopathy of prematurity (ROP) to predict late death or disability in premature infants at seven years of age. METHODS A retrospective study was performed at the 12 de Octubre Hospital neonatal unit in Madrid. A logistic model was applied to estimate the independent prognostic contribution of each morbidity, and the effect that the combination of morbidities had on the seven-year outcomes. The analysis was performed on the total cohort from 1991 to 2008 and on two subcohorts from 1991 to 1998 and 1999 to 2008. RESULTS A total of 1001 children were included with a mean birth weight of 922 ± 208 g. Severe ROP was strongly associated with poor neurodevelopment, with an odds ratio (OR) 3.17 and 95% confidence interval (CI) of 1.56-6.50, and so was BPD (OR 1.52, 95% CI: 1.03-2.2). The combination of two neonatal morbidities increased the risk of a poor outcome (OR 4.44, 95% CI: 1.51-7.86). The model behaved differently in the two subcohorts. CONCLUSION The prognostic model predicted a poor outcome at seven years of age when the subjects had at least two of the three morbidities.
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Manley BJ, McKinlay CJD. Antenatal and postnatal corticosteroids: Knowledge gaps and research priorities. Semin Fetal Neonatal Med 2019; 24:213-215. [PMID: 31147161 DOI: 10.1016/j.siny.2019.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Brett J Manley
- Neonatal Services and Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Australia.
| | - Chris J D McKinlay
- Liggins Institute, University of Auckland, Auckland, New Zealand; Kidz First Neonatal Care, Counties Manukau Health, Auckland, New Zealand
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Respiratory Medications in Infants <29 Weeks during the First Year Postdischarge: The Prematurity and Respiratory Outcomes Program (PROP) Consortium. J Pediatr 2019; 208:148-155.e3. [PMID: 30857774 PMCID: PMC6486865 DOI: 10.1016/j.jpeds.2018.12.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/10/2018] [Accepted: 12/05/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine patterns of respiratory medications used in neonatal intensive care unit graduates. STUDY DESIGN The Prematurity Respiratory Outcomes Program enrolled 835 babies <29 weeks of gestation in the first week. Of 751 survivors, 738 (98%) completed at least 1, and 85% completed all 4, postdischarge medication usage in-person/telephone parental questionnaires requested at 3, 6, 9, and 12 months of corrected age. Respiratory drug usage over the first year of life after in neonatal intensive care unit discharge was analyzed. RESULTS During any given quarter, 66%-75% of the babies received no respiratory medication and 45% of the infants received no respiratory drug over the first year. The most common postdischarge medication was the inhaled bronchodilator albuterol; its use increased significantly from 13% to 31%. Diuretic usage decreased significantly from 11% to 2% over the first year. Systemic steroids (prednisone, most commonly) were used in approximately 5% of subjects in any one quarter. Inhaled steroids significantly increased over the first year from 9% to 14% at 12 months. Drug exposure changed significantly based on gestational age with 72% of babies born at 23-24 weeks receiving at least 1 respiratory medication but only 40% of babies born at 28 weeks. Overall, at some time in the first year, 55% of infants received at least 1 drug including an inhaled bronchodilator (45%), an inhaled steroid (22%), a systemic steroid (15%), or diuretic (12%). CONCLUSION Many babies born at <29 weeks have no respiratory medication exposure postdischarge during the first year of life. Inhaled medications, including bronchodilators and steroids, increase over the first year.
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Jung YH, Jang J, Kim HS, Shin SH, Choi CW, Kim EK, Kim BI. Respiratory severity score as a predictive factor for severe bronchopulmonary dysplasia or death in extremely preterm infants. BMC Pediatr 2019; 19:121. [PMID: 31014304 PMCID: PMC6480897 DOI: 10.1186/s12887-019-1492-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/08/2019] [Indexed: 11/27/2022] Open
Abstract
Background Despite significant advances in neonatology, bronchopulmonary dysplasia (BPD) remains the most common cause of serious morbidity and mortality in premature infants. The aim of the present study was to determine associations between the respiratory severity score (RSS) with death or BPD in premature infants. Methods This was a retrospective study conducted between January 2010 and December 2014. We enrolled preterm infants with a gestational age of less than 28 weeks who were supported by mechanical ventilation for more than a week during the first 4 weeks of life. We collected the RSS scores on day of life 2, 7, 14, 21 and 28. The correlations between postnatal RSSs and death or severe BPD were analyzed using multivariate logistic regression. Results Of the 138 eligible infants, 66 infants (47.8%) either died or developed severe BPD. The RSS cut-off values for predicting severe BPD or death were 3.0 for postnatal day (PND) 14 with an odds ratio (OR) of 11.265 (p = 0.0006, 95% confidence interval (CI), 2.842 to 44.646), 3.6 for PND 21 with an OR of 15.162 (p = 0.0003, 95% CI, 3.467 to 66.316), and 3.24 for PND 28 with an OR of 10.713 (p = 0.0005, 95% CI, 2.825 to 40.630). Conclusion Strong correlations were observed between the RSSs on PND 14, 21, and 28 and death or subsequent severe BPD. The RSS could provide a simple estimate of severe BPD or death., Further research with a larger study population is necessary to validate the usefulness of the RSS for predicting severe BPD or death. Electronic supplementary material The online version of this article (10.1186/s12887-019-1492-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Young Hwa Jung
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, 13620, South Korea
| | - Jinhee Jang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, 13620, South Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea.
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Chang Won Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, 13620, South Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Beyong Il Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, 13620, South Korea
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