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Balog V, Lantos L, Valek A, Jermendy A, Somogyvari Z, Belteki G. Stabilization, respiratory care and survival of extremely low birth weight infants transferred on the first day of life. J Perinatol 2024:10.1038/s41372-024-02043-w. [PMID: 38969826 DOI: 10.1038/s41372-024-02043-w] [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: 02/02/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVE To assess stabilization, respiratory care and survival of extremely low birth weight (ELBW, <1000 g at birth) infants requiring emergency transfer to tertiary NICUs on the first day of life. STUDY DESIGN Retrospective cohort study of 55 ELBW infants transported by a dedicated neonatal transport service over a 65-month period. Ventilator data were downloaded computationally. RESULTS 95% of infants were intubated and received surfactant prior to transfer. Median expired tidal volume was 5.0 mL/kg (interquartile range: 4.6-6.2 mL/kg). Infants ventilated with SIPPV had significantly higher mean airway pressure and minute ventilation, but similar FiO2 compared to babies on SIMV. Blood gases showed significant improvement during transport. 55% of infants survived to discharge from NICU. CONCLUSION Most ELBW infants transferred on the first day of life require mechanical ventilation and can be ventilated with 5 mL/kg tidal volume.
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Affiliation(s)
- Vera Balog
- Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Lajos Lantos
- Neonatal Emergency & Transport Services of the Peter Cerny Foundation, Budapest, Hungary
| | - Andrea Valek
- Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Agnes Jermendy
- Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Zsolt Somogyvari
- Neonatal Emergency & Transport Services of the Peter Cerny Foundation, Budapest, Hungary
| | - Gusztav Belteki
- Neonatal Intensive Care Unit, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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Welke N, Lagatta J, Leuthner S, Acharya K. Three-Year Post-Neonatal Intensive Care Unit Health Care Utilization Among Infants with Congenital Anomalies. J Pediatr 2024; 265:113779. [PMID: 37852433 DOI: 10.1016/j.jpeds.2023.113779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/27/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To describe 3-year post-neonatal intensive care unit (NICU) health care use among children with congenital anomalies discharged home from a level IV NICU. STUDY DESIGN Retrospective chart review of children with congenital anomalies enrolled in a previous prospective cohort study from 201 to 2020. We assessed hospital readmission rate, number of surgeries, and durable medical equipment (DME) use by type of anomaly. RESULTS Among 166 infants enrolled in the original study, 158 survived to NICU discharge. One-third of the cohort had a genetic anomaly. Six of 158 patients (4%) died before 3 years of age. More than one-half the children were readmitted within the first 2 years of life, and one-third were readmitted in the third year of life. Readmissions were greatest for those with multiple, musculoskeletal, and central nervous system anomalies and lowest for abdominal-wall defects. Approximately one-half the children underwent surgeries, and this proportion remained constant over the 3-year time. Sixty-two percent of patients received DME at discharge, with gastrostomy tubes being the most common. Gastrostomy tubes were still present in 75% of the patients at 3 years of age. CONCLUSION Children with congenital anomalies are at risk for increased health care use during early childhood. Those with multiple anomalies, a genetic syndrome, musculoskeletal, and central nervous system anomalies and those discharged with DME are at greatest risk whereas those with abdominal-wall defects are at lowest risk. Provider awareness, high-quality discharge training, parent psychological support, greater assimilation of families in the NICU, and telehealth may be some strategies to better support these families.
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Affiliation(s)
- Nicole Welke
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Joanne Lagatta
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Steven Leuthner
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Krishna Acharya
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
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Santineau K, Abikoye TM, Guerin CM. Determinants of compliance with outpatient examinations for infants at risk for retinopathy of prematurity. J AAPOS 2024; 28:103813. [PMID: 38242229 DOI: 10.1016/j.jaapos.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 01/21/2024]
Abstract
PURPOSE To assess the level and the determinants of compliance with outpatient retinopathy of prematurity (ROP) examination appointments at a tertiary academic center. METHODS The medical records of babies scheduled for outpatient ROP examination between January 1, 2022, and December 31, 2022, were reviewed retrospectively. Data collected included appointments scheduled and attended, birth weight, gestational age, ROP staging at discharge, maternal ethnicity (self-identified), household type, proximity to hospital and median family income (US Census based on home zip codes). Univariate and multivariable analyses were performed. A P value of <0.05 was considered significant. RESULTS The records of 66 babies were analyzed. Forty-nine babies (74%) attended all scheduled ROP examination appointments (fully compliant). The mean appointment compliance rate was 86%, with a 1.5% no-show rate. Seven children (11%) required the intervention of Child Protective Services. One baby was never seen in the clinic. In unadjusted analysis, maternal ethnicity (P = 0.028) and median family income lower than the national average (P = 0.049) were sociodemographic factors associated with lower compliance. Clinical factors associated with lower compliance were lower gestational ages (P = 0.005) and lower birth weight (P = 0.006). In multivariable logistic regression adjusting for all candidate predictors, only birth weight remained significantly associated with lower compliance (P = 0.036). CONCLUSIONS Clinical and sociodemographic factors may be associated with compliance with outpatient ROP examination recommendations. Extremely low-birth-weight babies were at the greatest risk for noncompliance.
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Affiliation(s)
- Kaitlyn Santineau
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Temiloluwa M Abikoye
- Department of Ophthalmology and Visual Sciences, Texas Tech University Health Sciences Center, Lubbock Texas.
| | - Cynthia M Guerin
- Department of Ophthalmology and Visual Sciences, Texas Tech University Health Sciences Center, Lubbock Texas
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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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Long-term burden of respiratory complications associated with extreme prematurity: An analysis of US Medicaid claims. Pediatr Neonatol 2022; 63:503-511. [PMID: 35817695 DOI: 10.1016/j.pedneo.2022.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 05/17/2022] [Accepted: 05/25/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Infants born extremely premature (EP) (<28 weeks gestational age) are at high risk of complications, particularly bronchopulmonary dysplasia (BPD), which can develop into chronic lung disease (CLD). METHODS The burden of respiratory complications in EP infants up to 2 years corrected age (CA) was evaluated using real-world data from the US Medicaid program. Data recorded between 1997 and 2018 on EP infants without major congenital malformations were collected from Medicaid records of six states. EP infants were divided into three cohorts: BPD, CLD, and without BPD or CLD. The incidence of respiratory conditions, respiratory medication use, and healthcare resource utilization were compared between the BPD cohort and CLD cohort versus the cohort without BPD or CLD, using unadjusted and adjusted generalized linear models. RESULTS A total of 4462 EP infants were identified (17.4% of all premature infants in the database). Of these, BPD and CLD were diagnosed in 61.9% and 72.1%, respectively, and 14.5% were diagnosed with neither BPD nor CLD. Compared with infants without BPD or CLD, infants with BPD or CLD had more complications and a longer length of birth hospitalization stay. Respiratory distress syndrome was the most frequently reported complication (94.6%, 92.5%, and 82.3% of EP infants in the BPD, CLD, and without BPD or CLD cohorts, respectively). After the birth hospitalization, respiratory conditions, respiratory medication use, and incidence rates of rehospitalizations, emergency room visits, and outpatient visits were higher for infants with BPD or CLD. Rehospitalization occurred in 50.5%, 51.6%, and 27.3% of EP infants with BPD, CLD, or without BPD or CLD, respectively; most hospitalizations occurred for respiratory-related reasons. CONCLUSION In this analysis of a large population of EP infants up to 2 years CA, respiratory conditions were prevalent after the birth hospitalization and were associated with high rates of medication and healthcare resource utilization.
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Bogdan RD, Bohiltea RE, Toma AI. Respiratory Follow Up of the Premature Neonates-Rationale and Practical Issues. J Clin Med 2022; 11:1746. [PMID: 35330070 PMCID: PMC8955296 DOI: 10.3390/jcm11061746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/13/2022] [Accepted: 03/17/2022] [Indexed: 02/04/2023] Open
Abstract
The aim of the review was to present the state of knowledge about the respiratory pathology in former premature neonates (children that were born preterm-before 37 weeks of gestation-and are examined and evaluated after 40 weeks corrected age) other than chronic lung disease, in order to provide reasons for a respiratory follow-up program for this category of patients. After a search of the current evidence, we found that premature infants are prone to long-term respiratory consequences due to several reasons: development of the lung outside of the uterus, leading to dysmaturation of the structures, pulmonary pathology due to immaturity, infectious agents or mechanical ventilation and deficient control of breathing. The medium- to long-term respiratory consequences of being born before term are represented by an increased risk of respiratory infections (especially viral) during the first years of life, a risk of recurrent wheezing and asthma and a decrease in pulmonary volumes and airway flows. Late preterm infants have risks of pulmonary long-term consequences similar to other former premature infants. Due to all the above risks, premature neonates should be followed in an organized fashion, being examined at regular time intervals from discharge from the maternity hospital until adulthood-this could lead to an early detection of the risks and preventive therapies in order to improve their prognosis and assure a normal and productive life. The difficulties related to establishing such programs are represented by the insufficient standardization of the data gathering forms, clinical examinations and lung function tests, but it is our belief that if more premature infants are followed, the experience will allow standards to be established in these fields and the methods of data gathering and evaluation to be unified.
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Affiliation(s)
- Raluca Daniela Bogdan
- Pediatrics Department, Medicover Hospital, Str. Pechea No. 8, Sector 1, 031056 Bucharest, Romania;
| | - Roxana Elena Bohiltea
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bd Eroii Sanitari Nr 8, 050471 Bucharest, Romania
| | - Adrian Ioan Toma
- Neonatology Department, Life Memorial Hospital, Calea Grivitei No. 365, Sector 1, 010719 Bucharest, Romania
- Faculty of Medicine, University “Titu Maiorescu”, Str. Gh Petrascu 67, Sector 3, 031593 Bucharest, Romania
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Cho HY, Miller-DeGraff L, Perrow LA, Gladwell W, Panduri V, Lih FB, Kleeberger SR. Murine Neonatal Oxidant Lung Injury: NRF2-Dependent Predisposition to Adulthood Respiratory Viral Infection and Protection by Maternal Antioxidant. Antioxidants (Basel) 2021; 10:antiox10121874. [PMID: 34942977 PMCID: PMC8698620 DOI: 10.3390/antiox10121874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 12/04/2022] Open
Abstract
NRF2 protects against oxidant-associated airway disorders via cytoprotective gene induction. To examine if NRF2 is an important determinant of respiratory syncytial virus (RSV) susceptibility after neonate lung injury, Nrf2-deficient (Nrf2−/−) and wild-type (Nrf2+/+) mice neonatally exposed to hyperoxia were infected with RSV. To investigate the prenatal antioxidant effect on neonatal oxidative lung injury, time-pregnant Nrf2−/− and Nrf2+/+ mice were given an oral NRF2 agonist (sulforaphane) on embryonic days 11.5–17.5, and offspring were exposed to hyperoxia. Bronchoalveolar lavage and histopathologic analyses determined lung injury. cDNA microarray analyses were performed on placenta and neonatal lungs. RSV-induced pulmonary inflammation, injury, oxidation, and virus load were heightened in hyperoxia-exposed mice, and injury was more severe in hyperoxia-susceptible Nrf2−/− mice than in Nrf2+/+ mice. Maternal sulforaphane significantly alleviated hyperoxic lung injury in both neonate genotypes with more marked attenuation of severe neutrophilia, edema, oxidation, and alveolarization arrest in Nrf2−/− mice. Prenatal sulforaphane altered different genes with similar defensive functions (e.g., inhibition of cell/perinatal death and inflammation, potentiation of angiogenesis/organ development) in both strains, indicating compensatory transcriptome changes in Nrf2−/− mice. Conclusively, oxidative injury in underdeveloped lungs NRF2-dependently predisposed RSV susceptibility. In utero sulforaphane intervention suggested NRF2-dependent and -independent pulmonary protection mechanisms against early-life oxidant injury.
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Affiliation(s)
- Hye-Youn Cho
- Immunity, Inflammation and Disease Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC 27709, USA; (L.M.-D.); (L.A.P.); (W.G.); (S.R.K.)
- Correspondence: ; Tel.: +1-984-287-4088
| | - Laura Miller-DeGraff
- Immunity, Inflammation and Disease Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC 27709, USA; (L.M.-D.); (L.A.P.); (W.G.); (S.R.K.)
| | - Ligon A. Perrow
- Immunity, Inflammation and Disease Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC 27709, USA; (L.M.-D.); (L.A.P.); (W.G.); (S.R.K.)
| | - Wesley Gladwell
- Immunity, Inflammation and Disease Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC 27709, USA; (L.M.-D.); (L.A.P.); (W.G.); (S.R.K.)
| | - Vijayalakshmi Panduri
- Epigenetic and Stem Cell Biology Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC 27709, USA;
| | - Fred B. Lih
- Mass Spectrometry Research and Support Group, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC 27709, USA;
| | - Steven R. Kleeberger
- Immunity, Inflammation and Disease Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC 27709, USA; (L.M.-D.); (L.A.P.); (W.G.); (S.R.K.)
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Hauge SH, de Blasio BF, Håberg SE, Oakley L. Influenza hospitalizations during childhood in children born preterm. Influenza Other Respir Viruses 2021; 16:247-254. [PMID: 34519431 PMCID: PMC8818812 DOI: 10.1111/irv.12908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/28/2022] Open
Abstract
Objective The objective is to determine if children born preterm were at increased risk of influenza hospitalization up to age five. Methods National registry data on all children born in Norway between 2008 and 2011 were used in Cox regression models to estimate adjusted hazard ratios (aHRs) for influenza hospitalizations up to age five in children born preterm (<37 pregnancy weeks). HRs were also estimated separately for very preterm (<32 weeks), early term (37–38 weeks), and post‐term (≥42 weeks) children. Results Among 238,628 children born in Norway from January 2008 to December 2011, 15,086 (6.3%) were born preterm. There were 754 (0.3%) children hospitalized with influenza before age five. The rate of hospitalizations in children born preterm was 13.8 per 10,000 person‐years (95% confidence interval [CI] [11.3, 16.7]), and 5.9 per 10,000 person‐years (95% CI [5.5, 6.4]) in children born at term (≥37 weeks). Children born preterm had a higher risk of influenza hospitalization before age 5: aHR 2.33 (95% CI [1.85, 2.93]). The risk increased with decreasing gestational age and was highest among those born extremely/very preterm; aHR 4.07 (95% CI [2.63, 6.31]). Compared with children born at 40–41 weeks, children born early term also had an elevated risk of influenza hospitalization; aHR (37 weeks) 1.89 (95% CI [1.43, 2.50]), aHR (38 weeks) 1.43 (95% CI [1.15, 1.78]). Conclusion Children born preterm had a higher risk of influenza hospitalizations before age five. An elevated risk was also present among children born at an early term. Children born preterm could benefit from influenza vaccinations.
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Affiliation(s)
- Siri H Hauge
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Birgitte Freiesleben de Blasio
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Siri E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Laura Oakley
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Nsugbe E, Samuel OW, Sanusi I, Asogbon MG, Li G. A study on preterm birth predictions using physiological signals, medical health record information and low‐dimensional embedding methods. IET CYBER-SYSTEMS AND ROBOTICS 2021. [DOI: 10.1049/csy2.12031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
| | | | - Ibrahim Sanusi
- Department of Automatic Control and Systems Engineering The University of Sheffield Sheffield UK
| | | | - Guanglin Li
- Nsugbe Research Labs Swindon UK
- Shenzhen Institutes of Advanced Technology Chinese Academy of Sciences Shenzhen China
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Dylag AM, Haak J, Warren R, Yee M, Pryhuber GS, O'Reilly MA. Low Dose Hyperoxia Primes Airways for Fibrosis in Mice after Influenza A Infection. Am J Physiol Lung Cell Mol Physiol 2021; 321:L750-L763. [PMID: 34323115 DOI: 10.1152/ajplung.00289.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
It is well known that supplemental oxygen used to treat preterm infants in respiratory distress is associated with permanently disrupting lung development and the host response to influenza A virus (IAV). However, many infants who go home with normally functioning lungs are also at risk for hyperreactivity after a respiratory viral infection. We recently reported a new, low-dose hyperoxia mouse model (40% for 8 days; 40x8) that causes a transient change in lung function that resolves, rendering 40x8 adult animals functionally indistinguishable from room air controls. Here we reported that when infected with IAV, 40x8 mice display an early transient activation of TGFβ signaling and later airway hyperreactivity associated with peribronchial inflammation (profibrotic macrophages) and fibrosis compared to infected room air controls, suggesting neonatal oxygen induced hidden molecular changes that prime the lung for hyperreactive airways disease. While searching for potential activators of TGFβ signaling, we discovered that thrombospondin-1 (TSP-1) is elevated in naïve 40x8 mice compared to controls and localized to lung megakaryocytes and platelets before and during IAV infection. Elevated TSP-1 was also identified in human autopsy samples of former preterm infants with bronchopulmonary dysplasia. These findings reveal how low doses of oxygen that do not durably change lung function may prime it for hyperreactive airways disease by changing expression of genes, such as TSP-1, thus helping to explain why former preterm infants who have normal lung function are susceptible to airway obstruction and increased morbidity after viral infection.
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Affiliation(s)
- Andrew M Dylag
- Department of Pediatrics, University of Rochester, Rochester, NY, United States
| | - Jeannie Haak
- Department of Pediatrics, University of Rochester, Rochester, NY, United States
| | - Rachel Warren
- Department of Microbiology and Immunology, University of Rochester, Rochester, NY, United States
| | - Min Yee
- Department of Pediatrics, University of Rochester, Rochester, NY, United States
| | - Gloria S Pryhuber
- Department of Pediatrics, University of Rochester, Rochester, NY, United States
| | - Michael A O'Reilly
- Department of Pediatrics, University of Rochester, Rochester, NY, United States
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Callander EJ, Atwell K. The healthcare needs of preterm and extremely premature babies in Australia-assessing the long-term health service use and costs with a data linkage cohort study. Eur J Pediatr 2021; 180:2229-2236. [PMID: 33693978 DOI: 10.1007/s00431-021-04009-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/18/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022]
Abstract
The health conditions associated with extreme prematurity will likely require life-long treatment and management. As such, planning for the provision of healthcare services is essential in order to maximise their long-term well-being. We sought to quantify the use of healthcare services and the associated costs for extremely premature babies compared to preterm and term babies in Australia using a whole-of-population linked administrative dataset. In the first year of life, extremely premature babies had an average of 3.4 hospital admissions, and 2 emergency department presentations. They also had an average of 16 specialist attendances, 33 pathology tests and 6 diagnostic imaging tests performed. This was more than that utilised by preterm and full-term babies. The mean annual cost of hospitalisations was $182,312 for extremely premature babies in the first year and $9958 in the second year. The mean annual out-of-pocket fees for these services were $2212 and $121 in the first and second years respectively.Conclusion: Understanding the long-term healthcare needs of extremely premature babies in order to provide both an adequate number of services and also connection between services should be a central part of health system planning as the survival rates of extremely premature babies improve over time. What is Known: • The health service use of extremely premature babies is higher at the time of birth. • Health conditions and disabilities associated with extreme prematurity require life-long care. What is New: • Extremely premature babies have more diverse and frequent access to services than premature and term babies until at least age 2. • This comes at higher cost to families through out-of-pocket payments.
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Affiliation(s)
- Emily J Callander
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3181, Australia.
| | - Kerryn Atwell
- Southern Region, Tasmania Health Service, Hobart, Tasmania, 7000, Australia
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12
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Baysoy N, Kavuncuoğlu S, Ramoğlu MG, Aldemir EY, Payasli M. Follow-Up of Low Birth Weight Preterm Infants After Hospital Discharge: Incidence and Reasons for Rehospitalization. J Trop Pediatr 2021; 67:6290307. [PMID: 34059915 DOI: 10.1093/tropej/fmab029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES The rehospitalization frequency/indications of low birth weight (LBW) preterms and the effect of rehospitalization on growth and neurodevelopment were investigated. METHODS LBW preterms discharged from NICU were prospectively followed until the corrected age of 1 year. Infants rehospitalized after discharge were defined as the study group and those not rehospitalized as the control group. The frequency, duration and etiology of rehospitalization were investigated and the effects of neonatal complications, surgery and socio-demographic status on rehospitalization were assessed. RESULTS The study and the control group included 113 and 217 infants, respectively. Infants in the study group were rehospitalized 247 times in total. Rehospitalization was significantly higher in the male gender (39.7% vs. 28.9%, p < 0.05). Hyperbilirubinemia-anemia, anemia-surgery and pulmonary-other infections were the most common indications for rehospitalization in the 0-14 days, 15 days to 2 months and 2-12 months, respectively. Intrauterine growth had no impact on rehospitalization. Somatic growth and neurodevelopment were significantly delayed in the study group (p < 0.05). CONCLUSION Birth weight and gestational week are the most important determinants of rehospitalization. Rehospitalized preterm infants have significant deficits in both somatic growth and neurodevelopment despite high-quality follow-up care.
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Affiliation(s)
- Nihal Baysoy
- Department of Pediatrics, Kanuni Sultan Süleyman Education and Research Hospital, Istanbul, Turkey
| | - Sultan Kavuncuoğlu
- Department of Neonatology, Kanuni Sultan Süleyman Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Gökhan Ramoğlu
- Department of Pediatric Cardiology, Ankara University Medical Faculty, Ankara, Turkey
| | - Esin Yildiz Aldemir
- Department of Neonatology, Kanuni Sultan Süleyman Education and Research Hospital, Istanbul, Turkey
| | - Müge Payasli
- Department of Neonatology, Kanuni Sultan Süleyman Education and Research Hospital, Istanbul, Turkey
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Five Year Follow Up of Extremely Low Gestational Age Infants after Timely or Delayed Administration of Routine Vaccinations. Vaccines (Basel) 2021; 9:vaccines9050493. [PMID: 34065878 PMCID: PMC8150373 DOI: 10.3390/vaccines9050493] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/20/2021] [Accepted: 05/07/2021] [Indexed: 12/19/2022] Open
Abstract
This study is aimed at detecting the rate of untimely immunization in a large cohort of extremely low gestational age neonates (ELGANs) of the German Neonatal Network (GNN) and at addressing risk factors for delayed vaccination and associated long-term consequences. We performed an observational study of the GNN between 1st January 2010 and 31st December 2019. The immunization status for the hexavalent and pneumococcal immunization was evaluated in n = 8401 preterm infants <29 weeks of gestation. Univariate analysis and logistic/linear regression models were used to identify risk factors for vaccination delay and outcomes at a 5-year follow-up. In our cohort n = 824 (9.8%) ELGANs did not receive a timely first immunization with the hexavalent and pneumococcal vaccine. Risk factors for delayed vaccination were SGA status (18.1% vs. 13.5%; OR 1.3; 95% CI: 1.1–1.7), impaired growth and surrogates for complicated clinical courses (i.e., need for inotropes, necrotizing enterocolitis). At 5 years of age, timely immunized children had a lower risk of bronchitis (episodes within last year: 27.3% vs. 37.7%; OR 0.60, 95% CI: 0.42–0.86) but spirometry measures were unaffected. In conclusion, a significant proportion of ELGANs are untimely immunized, specifically those with increased vulnerability, even though they might particularly benefit from the immune-promoting effects of a timely vaccination.
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14
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McKinney RL, Schmidhoefer JJ, Balasco AL, Machan JT, Hirway P, Keszler M. Severe bronchopulmonary dysplasia: outcomes before and after the implementation of an inpatient multidisciplinary team. J Perinatol 2021; 41:544-550. [PMID: 33097819 PMCID: PMC7581687 DOI: 10.1038/s41372-020-00863-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/01/2020] [Accepted: 10/08/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Severe bronchopulmonary dysplasia (sBPD) can lead to long term morbidity. We created a sBPD multidisciplinary team in 2011 to optimize care and improve outcomes. STUDY DESIGN Retrospective chart review of three groups between 2008 and 2016: patients with sBPD born before 2011, patients with sBPD born after 2011, and patients with moderate BPD born after 2011. RESULTS Infants with sBPD after 2011 had a shorter NICU length of stay compared with children born before 2011 (mean 140 days vs 170 days p < 0.007), weighed more at discharge (z-score -0.8 vs -1.35 p = 0.01), had less failure to thrive post discharge (32% vs 51% p = 0.05) and had more well visits in the first six months of life (mean 6.7 vs 5.3 p = 0.04). No difference was observed in the rate of readmissions in the first two years of life. CONCLUSION Our multidisciplinary team has improved the inpatient management of patients with sBPD.
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Affiliation(s)
- Robin L. McKinney
- grid.40263.330000 0004 1936 9094Department of Pediatrics, The Warren Alpert School of Medicine at Brown University, Providence, RI USA
| | - Joseph J. Schmidhoefer
- grid.40263.330000 0004 1936 9094Department of Pediatrics, The Warren Alpert School of Medicine at Brown University, Providence, RI USA
| | - Alyssa L. Balasco
- grid.40263.330000 0004 1936 9094Department of Pediatrics, The Warren Alpert School of Medicine at Brown University, Providence, RI USA
| | - Jason T. Machan
- grid.40263.330000 0004 1936 9094Lifespan Biostatistics Core and Departments of Orthopedics and Surgery, Warren Alpert Medical School, Brown University, Providence, RI USA
| | - Priya Hirway
- grid.40263.330000 0004 1936 9094Department of Pediatrics, The Warren Alpert School of Medicine at Brown University, Providence, RI USA
| | - Martin Keszler
- grid.40263.330000 0004 1936 9094Department of Pediatrics, The Warren Alpert School of Medicine at Brown University, Providence, RI USA
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15
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Al-Hindi M, Alshamrani Z, Alkhotani W, Albassam A, Amin Tashkandi A, AlQurashi M. Utilization of health-care resources of preterm infants during their first 2 years of life after discharge from neonatal intensive care unit. J Clin Neonatol 2021. [DOI: 10.4103/jcn.jcn_204_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Check J, Jensen ET, Skelton JA, Ambrosius WT, O'Shea TM. Early growth outcomes in very low birth weight infants with bronchopulmonary dysplasia or fetal growth restriction. Pediatr Res 2020; 88:601-604. [PMID: 32061195 DOI: 10.1038/s41390-020-0808-7] [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] [Received: 09/11/2019] [Revised: 01/29/2020] [Accepted: 02/07/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND To assess the growth outcomes at 18 months corrected age in very low birth weight (VLBW) infants compared to standardized norms, and in VLBW infants with and without bronchopulmonary dysplasia (BPD) or fetal growth restriction (FGR). METHODS In all, 1149 VLBW infants completed anthropometrics at 18 months corrected age. To derive weight, height, and body mass index (BMI) percentiles and z-scores at 18 months, we used the SAS macro from the Centers for Disease Control and Prevention (CDC). z-scores for a child's sex and age are based on the World Health Organization's growth charts for children <24 months of age. RESULTS Female and male VLBW infants had higher body-mass-index (BMI)-for-age z-scores compared to normative data (0.82 and 1.77 respectively). No significant difference was found in BMI-for-age z-scores in BPD and non-BPD (1.76 vs. 2.3; p = 0.4), nor in FGR and non-FGR (1.24 vs. 2.16; p = 0.2). CONCLUSIONS At 18 months corrected age, VLBW infants, including those with BPD or FGR, had BMI-for-age z-scores higher than reference standards. No significant difference was seen comparing BMI-for-age z-scores in the BPD/non-BPD and FGR/non-FGR groups.
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Affiliation(s)
- Jennifer Check
- Department of Pediatrics, Wake Forest University School of Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA.
| | - Elizabeth T Jensen
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest University School of Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Walter T Ambrosius
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest University School of Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - T Michael O'Shea
- Department of Pediatrics, University of North Carolina at Chapel Hill, UNC Hospitals, Chapel Hill, NC, USA
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17
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Varley-Campbell J, Mújica-Mota R, Coelho H, Ocean N, Barnish M, Packman D, Dodman S, Cooper C, Snowsill T, Kay T, Liversedge N, Parr M, Knight L, Hyde C, Shennan A, Hoyle M. Three biomarker tests to help diagnose preterm labour: a systematic review and economic evaluation. Health Technol Assess 2020; 23:1-226. [PMID: 30917097 DOI: 10.3310/hta23130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Preterm birth may result in short- and long-term health problems for the child. Accurate diagnoses of preterm births could prevent unnecessary (or ensure appropriate) admissions into hospitals or transfers to specialist units. OBJECTIVES The purpose of this report is to assess the test accuracy, clinical effectiveness and cost-effectiveness of the diagnostic tests PartoSure™ (Parsagen Diagnostics Inc., Boston, MA, USA), Actim® Partus (Medix Biochemica, Espoo, Finland) and the Rapid Fetal Fibronectin (fFN)® 10Q Cassette Kit (Hologic, Inc., Marlborough, MA, USA) at thresholds ≠50 ng/ml [quantitative fFN (qfFN)] for women presenting with signs and symptoms of preterm labour relative to fFN at 50 ng/ml. METHODS Systematic reviews of the published literature were conducted for diagnostic test accuracy (DTA) studies of PartoSure, Actim Partus and qfFN for predicting preterm birth, the clinical effectiveness following treatment decisions informed by test results and economic evaluations of the tests. A model-based economic evaluation was also conducted to extrapolate long-term outcomes from the results of the diagnostic tests. The model followed the structure of the model that informed the 2015 National Institute for Health and Care Excellence guidelines on preterm labour diagnosis and treatment, but with antenatal steroids use, as opposed to tocolysis, driving health outcomes. RESULTS Twenty studies were identified evaluating DTA against the reference standard of delivery within 7 days and seven studies were identified evaluating DTA against the reference standard of delivery within 48 hours. Two studies assessed two of the index tests within the same population. One study demonstrated that depending on the threshold used, qfFN was more or less accurate than Actim Partus, whereas the other indicated little difference between PartoSure and Actim Partus. No study assessing qfFN and PartoSure in the same population was identified. The test accuracy results from the other included studies revealed a high level of uncertainty, primarily attributable to substantial methodological, clinical and statistical heterogeneity between studies. No study compared all three tests simultaneously. No clinical effectiveness studies evaluating any of the three biomarker tests were identified. One partial economic evaluation was identified for predicting preterm birth. It assessed the number needed to treat to prevent a respiratory distress syndrome case with a 'treat-all' strategy, relative to testing with qualitative fFN. Because of the lack of data, our de novo model involved the assumption that management of pregnant women fully adhered to the results of the tests. In the base-case analysis for a woman at 30 weeks' gestation, Actim Partus had lower health-care costs and fewer quality-adjusted life-years (QALYs) than qfFN at 50 ng/ml, reducing costs at a rate of £56,030 per QALY lost compared with qfFN at 50 ng/ml. PartoSure is less costly than Actim Partus while being equally effective, but this is based on diagnostic accuracy data from a small study. Treatment with qfFN at 200 ng/ml and 500 ng/ml resulted in lower cost savings per QALY lost relative to fFN at 50 ng/ml than treatment with Actim Partus. In contrast, qfFN at 10 ng/ml increased QALYs, by 0.002, and had a cost per QALY gained of £140,267 relative to fFN at 50 ng/ml. Similar qualitative results were obtained for women presenting at different gestational ages. CONCLUSION There is a high degree of uncertainty surrounding the test accuracy and cost-effectiveness results. We are aware of four ongoing UK trials, two of which plan to enrol > 1000 participants. The results of these trials may significantly alter the findings presented here. STUDY REGISTRATION The study is registered as PROSPERO CRD42017072696. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Jo Varley-Campbell
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Rubén Mújica-Mota
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Helen Coelho
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Neel Ocean
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Max Barnish
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - David Packman
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Sophie Dodman
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Chris Cooper
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Tristan Snowsill
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK.,Health Economics Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Tracey Kay
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Michelle Parr
- Central Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - Lisa Knight
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Chris Hyde
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Andrew Shennan
- Department of Women and Children's Health, King's College London, London, UK.,Guy's and St Thomas' Hospital, London, UK
| | - Martin Hoyle
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
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18
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Manti S, Galdo F, Parisi GF, Napolitano M, Decimo F, Leonardi S, Miraglia Del Giudice M. Long-term effects of bronchopulmonary dysplasia on lung function: a pilot study in preschool children's cohort. J Asthma 2020; 58:1186-1193. [PMID: 32508174 DOI: 10.1080/02770903.2020.1779289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Although the long term negative effects of bronchopulmonary dysplasia (BPD) are well known, follow-up studies of preterm infants with BPD into childhood are lacking. METHODS Forty-two preschool children (age range 3-6 years) who were born before 32 weeks of gestational age and affected by BPD were enrolled. Pre-, peri-, and post-natal data were collected. During the follow up appointment complete physical examination and lung function (impulse oscillometry (IOS)) were recorded. The European Community Respiratory Health Survey (ECRHS) questionnaire was administered to all enrolled subjects. RESULTS Thirty patients were included in the final analysis. The BPD group did not differ in comparison to the non-BPD group in terms of lung function (p > 0.05). By comparing all subjects enrolled, We detected extremely low-birth-weight (ELBW) infants with height-, weight-, and gender-related reference values and a significant trend of increasing resistance values (R5Hz, R5-20 Hz) and respiratory impedance (Z5Hz) (p < 0.05). No significant difference in bronchial reversibility test was observed among BPD non-BPD groups (p < 0.05). The frequency of gastroesophageal reflux disease was significantly higher in patients with BPD when compared to non-BPD group (p < 0.05). Significant differences in gestational age, oxygen supplementation (days), mechanical ventilation therapy (days), and sepsis between BPD and non-BPD groups were also observed (p < 0.05). There were no significant differences in the prevalence of family and personal history of atopy and/or allergic diseases, tobacco exposure, respiratory symptoms, respiratory syncytial virus bronchiolitis, exercise induced dyspnea, treatment with ß-2 bronchodilators and inhaled corticosteroids among the groups (p > 0.05). CONCLUSIONS The respiratory function in preschool children born with ELBW is characterized by an increase in impedance and resistance of small airways. No statistically significant differences were found between ELBW children with BPD and without BPD. With regards to the smallest gestational age, the longer duration of O2 therapy during hospitalization, and sepsis significantly resulted in a worse respiratory function.
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Affiliation(s)
- S Manti
- AOU Policlinico-Vittorio Emanuele, Respiratory Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - F Galdo
- Department of Woman. Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - G F Parisi
- AOU Policlinico-Vittorio Emanuele, Respiratory Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - F Decimo
- Department of Woman. Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - S Leonardi
- AOU Policlinico-Vittorio Emanuele, Respiratory Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - M Miraglia Del Giudice
- Department of Woman. Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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19
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Viemann D. S100-Alarmins Are Essential Pilots of Postnatal Innate Immune Adaptation. Front Immunol 2020; 11:688. [PMID: 32425933 PMCID: PMC7203218 DOI: 10.3389/fimmu.2020.00688] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/26/2020] [Indexed: 12/14/2022] Open
Abstract
The restricted capacity of newborn infants to mount inflammatory responses toward microbial challenges has traditionally been linked to the high risk of septic diseases during the neonatal period. In recent years, substantial evidence has been provided that this characteristic of the neonatal immune system is actually a meaningful physiologic state that is based on specific transiently active cellular and molecular mechanisms and required for a favorable course of postnatal immune adaptation. The identification of physiologically high amounts of S100-alarmins in neonates has been one of the crucial pieces in the puzzle that contributed to the change of concept. In this context, innate immune immaturity could be redefined and assigned to the epigenetic silence of adult-like cell-autonomous regulation at the beginning of life. S100-alarmins represent an alternative age-specific mechanism of immune regulation that protects neonates from hyperinflammatory immune responses. Here, we summarize how infants are provided with S100-alarmins and why these allow an uneventful clash between the innate immune system and the extrauterine world. The mode of action of S100-alarmins is highlighted including their tuning functions at multiple levels for establishing a state of homeostasis with the environment in the newborn individual.
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Affiliation(s)
- Dorothee Viemann
- Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hanover, Germany.,Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hanover, Germany.,PRIMAL Consortium, Hanover, Germany
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20
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Bogdan RD, Rusu L, Toma AI, Nastase L. Respiratory Outcome of the Former Premature Infants. J Med Life 2020; 12:381-394. [PMID: 32025257 PMCID: PMC6993307 DOI: 10.25122/jml-2019-0123] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The research aims to identify the respiratory pathology during the first two years of life in premature infants with gestational ages between 30-34 weeks and the risk factors for these conditions (familial, prenatal, and neonatal). There were investigated 31 premature infants with gestational ages between 30-34 weeks and the incidence of bronchopulmonary dysplasia, infections with the respiratory syncytial virus, or other viral infections requiring hospitalization, recurrent wheezing, and nasal colonization with pathogenic bacteria were noted. Also, regression models for each type of respiratory pathology as a function of the antenatal (smoking in the family, atopy, mother’s age) and neonatal (gestational age, respiratory distress syndrome, duration of the treatment with antibiotics, use of the reserve antibiotics) factors were elaborated. Respiratory distress syndrome was present in 20 premature infants, and 19 infants received respiratory support. Two former premature infants presented with bronchopulmonary dysplasia, 3 with severe respiratory syncytial virus infections, 7 with recurrent wheezing, and 16 with viral infections requiring hospitalization. Respiratory distress syndrome and severe viral infections were more frequently found in families of smokers. Low gestational age and familial atopy were identified as good predictors of severe respiratory syncytial virus infections (p< 0.03) Premature infants with gestational ages between 30-34 weeks present with the risk of appearance of respiratory diseases during the first two years of life, especially disorders of the airways. Familial atopy and low gestational age represent independent risk factors for severe respiratory syncytial virus infections.
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Affiliation(s)
| | - Lidia Rusu
- Regional Center of Public Health, Iasi, Romania
| | | | - Leonard Nastase
- Alessandrescu - Rusescu National Institute of Mother and Child Health, Bucharest, Romania
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21
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Ochoa TJ, Zegarra J, Bellomo S, Carcamo CP, Cam L, Castañeda A, Villavicencio A, Gonzales J, Rueda MS, Turin CG, Zea-Vera A, Guillen D, Campos M, Ewing-Cobbs L. Randomized Controlled Trial of Bovine Lactoferrin for Prevention of Sepsis and Neurodevelopment Impairment in Infants Weighing Less Than 2000 Grams. J Pediatr 2020; 219:118-125.e5. [PMID: 32037149 PMCID: PMC7096260 DOI: 10.1016/j.jpeds.2019.12.038] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 11/25/2019] [Accepted: 12/17/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To determine the effect of bovine lactoferrin on prevention of late-onset sepsis (LOS) and neurodevelopment delay. STUDY DESIGN Randomized, double-blind, controlled trial in neonates with a birth weight of 500-2000 g in 3 neonatal units in Lima, Peru, comparing bovine lactoferrin 200 mg/kg/day with placebo administered for 8 weeks. The primary outcome was the first episode of culture-proven LOS or sepsis-associated death. Neurodevelopment delay was assessed by the Mullen Scales at 24 months corrected age. RESULTS Of the 414 infants enrolled, 209 received bovine lactoferrin and 205 received placebo. LOS or sepsis-associated death occurred in 22 infants (10.5%) in the bovine lactoferrin group vs 30 (14.6%) in the placebo group; there was no difference after adjusting for hospital and birth weight; hazard ratio 0.73 (95% CI, 0.42-1.26). For infants with birth weights of <1500 g the hazard ratio was 0.69 (95% CI, 0.39-1.25). The mean age-adjusted normalized Mullen composite score at 24 months was 83.3 ± 13.6 in the bovine lactoferrin group vs 82.6 ± 13.1 in the placebo group. Growth outcomes and rehospitalization rates during the 2-year follow-up were similar in both groups, except for significantly less bronchiolitis in the bovine lactoferrin group (rate ratio, 0.34; 95% CI, 0.14-0.86). CONCLUSIONS Supplementation with bovine lactoferrin did not decrease the incidence of sepsis in infants with birth weights of <2000 g. Growth and neurodevelopment outcomes at 24 months of age were similar. Neonatal bovine lactoferrin supplementation had no adverse effects. TRIAL REGISTRATION ClinicalTrials.gov: NCT01525316.
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Affiliation(s)
- Theresa J. Ochoa
- Department of Pediatrics, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru,Instituto de Medicina Tropical “Alexander von Humboldt”, Universidad Peruana Cayetano Heredia, Lima, Peru,Center for Infectious Diseases, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, United States
| | - Jaime Zegarra
- Department of Pediatrics, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru,Hospital Cayetano Heredia, Lima, Peru
| | - Sicilia Bellomo
- Department of Pediatrics, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru,Hospital Cayetano Heredia, Lima, Peru
| | - Cesar P. Carcamo
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luis Cam
- Hospital Nacional Alberto Sabogal, Lima, Peru
| | | | - Aasith Villavicencio
- Department of Pediatrics, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jorge Gonzales
- Department of Pediatrics, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria S. Rueda
- Department of Pediatrics, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Christie G. Turin
- Department of Pediatrics, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Alonso Zea-Vera
- Department of Pediatrics, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Daniel Guillen
- Department of Pediatrics, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru,Hospital Cayetano Heredia, Lima, Peru
| | - Miguel Campos
- Department of Mathematics, School of Science and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Linda Ewing-Cobbs
- Department of Pediatrics and Children’s Learning Institute, School of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, United States
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22
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Health literacy of parents of very preterm infants at NICU admission and discharge: a prospective cohort study. J Perinatol 2019; 39:866-875. [PMID: 30770882 DOI: 10.1038/s41372-019-0340-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/23/2019] [Accepted: 01/30/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the prevalence of limited health literacy in parents of infants born ≤32 and 0/7 weeks and if health literacy changes during hospitalization. STUDY DESIGN Multi-site, prospective cohort study measuring health literacy using the Parent Health Literacy Activities Test, which estimates caregivers' ability to complete tasks such as reading prescription labels and preparing bottles. Data were analyzed using parametric and nonparametric comparison tests and multivariable regression to control for confounders. RESULT Of the 137 participants, 31% missed ≥3 questions of 8. Scores were not associated with admission characteristics or NICU complications. Lower scores were associated with lower nurses' (rho 0.20, p = 0.04) but not parents' (rho -0.12, p = 0.22) ratings of discharge readiness. Scores improved slightly from admission to discharge (p = 0.049). CONCLUSION Many parents have difficulty answering questions related to basic infant care tasks. NICUs should ensure that communication and discharge planning are mindful of health literacy.
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23
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Honda M, Som R, Seang S, Tung R, Iwamoto A. One year outcome of high-risk newborn infants discharged from the neonatal care unit of the National Maternal and Child Health Center in Cambodia. Heliyon 2019; 5:e01446. [PMID: 31008390 PMCID: PMC6458445 DOI: 10.1016/j.heliyon.2019.e01446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 01/12/2019] [Accepted: 03/26/2019] [Indexed: 11/30/2022] Open
Abstract
Background In the National Maternal and Child Health Center in Cambodia, about 7,500 newborn infants are born every year. Around 10% of them are admitted to the neonatal care unit. After recovery from the acute phase that presented neonatal care unit admissions, they are discharged even if they are very low birth weight infants, but there is no official follow-up system available after discharge. This research aims to identify the prognosis of high-risk infants one year after discharge using regular telephone interviews, identifying the factors that may determine their prognosis. Methods When a small and sick newborn infant was admitted to and discharged from the neonatal care unit, we collected health information from medical records. After discharge, we interviewed their caretakers by telephone when the infants were one, six, and 12 months (one year) old. We used structured questionnaires on feeding, history of illness, and development of growth and gross motor skills. Findings Between September 2014 and April 2015, 175 infants were discharged. At one year old, 111 (63%) had survived, 12 (6.9%) had died, and 52 (30%) were lost to follow-up. Nine cases died within one month of discharge. Our data suggested low birth weight may lead to re-hospitalization. Infants vaccinated less than twice at six months old were more likely to be re-hospitalized. According to results of our telephone interview, three infants showed psychomotor retardation at one year old. Among the 50 cases lost to follow-up, 26 (52%) of these patients were discharged without permission by doctors. Interpretation After one year, we noted that 63% of discharged infants survived, although 30% were lost to follow-up. There was a limitation of collecting more detailed data by telephone interview than questions about survival. The follow-up for high-risk newborn infants is an important challenge in Cambodia.
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Affiliation(s)
- Mari Honda
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo 162-8655, Japan
| | - Rithy Som
- National Maternal and Child Health Center, #31A, St.47, Sras Chork, Daun Penh, Phnom Penh, Cambodia
| | - Sody Seang
- National Maternal and Child Health Center, #31A, St.47, Sras Chork, Daun Penh, Phnom Penh, Cambodia
| | - Rathavy Tung
- National Maternal and Child Health Center, #31A, St.47, Sras Chork, Daun Penh, Phnom Penh, Cambodia
| | - Azusa Iwamoto
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo 162-8655, Japan
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Youn Y, Lee SM, Hwang JH, Cho SJ, Kim EK, Kim EAR. National Registry Data from Korean Neonatal Network: Two-Year Outcomes of Korean Very Low Birth Weight Infants Born in 2013-2014. J Korean Med Sci 2018; 33:e309. [PMID: 30473651 PMCID: PMC6249169 DOI: 10.3346/jkms.2018.33.e309] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/16/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The aim of this study was to observe long-term outcomes of very low birth weight infants (VLBWIs) born between 2013 and 2014 in Korea, especially focusing on neurodevelopmental outcomes. METHODS The data were collected from Korean Neonatal Network (KNN) registry from 43 and 54 participating units in 2013 and 2014, respectively. A standardized electronic case report form containing 30 items related to long-term follow up was used after data validation. RESULTS Of 2,660 VLBWI, the mean gestational age and birth weight were 291/7 ± 26/7 weeks and 1,093 ± 268 g in 2013 and 292/7 ± 26/7 weeks and 1,125 ± 261 g in 2014, respectively. The post-discharge mortality rate was 1.2%-1.5%. Weight < 50th percentile was 46.5% in 2013 and 66.1% in 2014. The overall prevalence of cerebral palsy among the follow up infants was 6.2% in 2013 and 6.6% in 2014. The Bayley Scales of Infant Developmental Outcomes version II showed 14%-25% of infants had developmental delay and 3%-8% of infants in Bayley version III. For the Korean developmental screening test for infants and children, the area "Further evaluation needed" was 5%-12%. Blindness in both eyes was reported to be 0.2%-0.3%. For hearing impairment, 0.8%-1.9% showed bilateral hearing loss. Almost 50% were readmitted to hospital with respiratory illness as a leading cause. CONCLUSION The overall prevalence of long-term outcomes was not largely different among the VLBWI born between 2013 and 2014. This study is the first large national data study of long-term outcomes.
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Affiliation(s)
- YoungAh Youn
- Department of Pediatrics, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Soon Min Lee
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Hee Hwang
- Department of Pediatrics, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Su Jin Cho
- Department of Pediatrics, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Ee-Kyung Kim
- Departmemt of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Ellen Ai-Rhan Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
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Yu X, Zhang J. Family-centred care for hospitalized preterm infants: A systematic review and meta-analysis. Int J Nurs Pract 2018; 25:e12705. [PMID: 30378217 DOI: 10.1111/ijn.12705] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 09/21/2018] [Accepted: 09/30/2018] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the effects of family-centred care on hospitalized preterm infants. BACKGROUND With an increase in published reports on family-centred care for preterm infants, there is a need for an up-to-date review and meta-analysis of rigorously designed studies to measure the effects of family-centred care on preterm infants. DESIGN A systematic review and meta-analysis. DATA SOURCES The Cochrane Library (Issue 12, 2017), PubMed (1966 to December 2017), CINAHL (1982 to December 2017), EMBASE (1974 to December 2017), and Web of Science (1975 to December 2017) databases were searched. REVIEW METHODS Relevant terms were used to search for randomized controlled trials of family-centred care versus standard care. A modified rating scale was utilized to assess studies for the degree of family-centredness of the intervention. RESULTS Four studies involving 1026 preterm infants were included. Compared with standard care, family-centred care shortened the total length of hospital stay and length of neonatal intensive care unit stay. There was inadequate evidence to demonstrate any effects of family-centred care on infant morbidity, feeding, growth, or neurobehavioural performance. CONCLUSION Family-centred care is an effective and safe intervention to shorten the length of stay in the hospital and improve survival quality among hospitalized preterm infants.
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Affiliation(s)
- Xiaoyan Yu
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Jun Zhang
- School of Health Sciences, Wuhan University, Wuhan, China
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Li M, Pan B, Shi Y, Fu J, Xue X. Increased expression of CHOP and LC3B in newborn rats with bronchopulmonary dysplasia. Int J Mol Med 2018; 42:1653-1665. [PMID: 29901175 DOI: 10.3892/ijmm.2018.3724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 05/09/2018] [Indexed: 11/06/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) seriously affects the health and prognosis of children, but the efficacy of treatments is poor. The present study aimed to examine the effects of C/EBP homologous protein (CHOP), activating transcription factor 4 (ATF4) and microtubule‑associated protein light chain 3β (LC3B), and the interaction between CHOP and LC3B, in newborn rats with BPD. At 1, 7, 14 and 21 days, the rats in the model [fraction of inspired oxygen (FiO2)=80‑85%] and control groups (FiO2=21%) were randomly sacrificed, and lung samples were collected. Alveolar development was evaluated according to the radial alveolar count (RAC) and alveolar septum thickness. Ultrastructural changes were observed by transmission electron microscopy (TEM), the expression levels of CHOP, ATF4 and LC3B were determined by immunohistochemistry, and western blot and reverse transcription‑quantitative polymerase chain reaction analyses. The co‑localization of CHOP and LC3B in lung tissues was determined by immunofluorescence. The results showed that, compared with the control group, alveolarization arrest was present in the model group. The TEM observations revealed that, at 14 days, type II alveolar epithelial cell (AECII) lamellar bodies were damaged, with an apparent dilation of the endoplasmic reticulum (ER) and autophagy in cells within the model group. Between days 7 and 14, the protein levels of ATF4, CHOP and LC3B were significantly increased in the model group. The mRNA levels of CHOP and LC3B were lower at days 7‑21. CHOP and LC3B were co‑localized in the cells of the lung tissues at day 14 in the model group. Pearson's correlation analysis showed that the protein levels of CHOP and LC3B‑II were positively correlated in the model groups. As in previous studies, the present study demonstrated that BPD damaged the AECII cells, which exhibited detached and sparse microvilli and the vacuolization of lamellar bodies. In addition, it was found that the ER was dilated, with autophagosomes containing ER and other organelles in AECII cells; the expression levels of CHOP and LC3B‑II were upregulated. CHOP and LC3B‑II may have joint involvement in the occurrence and development of BPD.
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Affiliation(s)
- Mengyun Li
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Bingting Pan
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Yongyan Shi
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Jianhua Fu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Xindong Xue
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
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Skromme K, Vollsæter M, Øymar K, Markestad T, Halvorsen T. Respiratory morbidity through the first decade of life in a national cohort of children born extremely preterm. BMC Pediatr 2018. [PMID: 29514655 PMCID: PMC5840932 DOI: 10.1186/s12887-018-1045-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Advances in perinatal care have markedly increased the prospects of survival for infants born extremely preterm (EP). The aim of this study was to investigate hospitalisation rates and respiratory morbidity from five to 11 years of age in a prospective national cohort of EP children born in the surfactant era. METHODS This was a national prospective cohort study of all children born in Norway during 1999 and 2000 with gestational age (GA) < 28 weeks or birth weight < 1000 grams, and of individually matched term-born controls recruited for a regional subsample. Data on hospital admissions, respiratory symptoms, and use of asthma medication was obtained by parental questionnaires at 11 years of age. RESULTS Questionnaires were returned for 232/372 (62%) EP-born and 57/61 (93%) regional term-born controls. Throughout the study period, 67 (29%) EP-born and seven (13%) term-born controls were admitted to hospital (odds ratio (OR) 2.90, 95% confidence interval (CI): 1.25, 6.72). Admissions were mainly due to surgical procedures, with only 12% due to respiratory causes, and were not influenced by neonatal bronchopulmonary dysplasia (BPD) or low GA(≤ 25 weeks). Respiratory symptoms, asthma and use of asthma medication tended to be more common for EP-born, significantly so for medication use and wheeze on exercise. Neonatal BPD was a risk factor for medication use, but not for current wheeze. In multivariate regression models, home oxygen after discharge (OR 4.84, 95% CI: 1.38, 17.06) and parental asthma (OR 4.38, 95% CI: 1.69, 11.38) predicted current asthma, but neither BPD nor low GA were associated with respiratory symptoms at 11 years of age. CONCLUSIONS Hospitalisation rates five to 11 years after EP birth were low, but twice those of term-born controls, and unrelated to neonatal BPD and low GA. Respiratory causes were rare. Respiratory complaints were more common in children born EP, but the burden of symptoms had declined since early childhood.
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Affiliation(s)
- Kaia Skromme
- Department of Pediatrics, Haukeland University Hospital, N-5021, Bergen, Norway.
| | - Maria Vollsæter
- Department of Pediatrics, Haukeland University Hospital, N-5021, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Knut Øymar
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.,Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway
| | - Trond Markestad
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Thomas Halvorsen
- Department of Pediatrics, Haukeland University Hospital, N-5021, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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Isayama T, Lewis-Mikhael AM, O'Reilly D, Beyene J, McDonald SD. Health Services Use by Late Preterm and Term Infants From Infancy to Adulthood: A Meta-analysis. Pediatrics 2017; 140:peds.2017-0266. [PMID: 28759410 DOI: 10.1542/peds.2017-0266] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Late-preterm infants born at 34 to 36 weeks' gestation have increased risks of various health problems. Health service utilization (HSU) of late-preterm infants has not been systematically summarized before. OBJECTIVES To summarize the published literature on short- and long-term HSU by late-preterm infants versus term infants from infancy to adulthood after initial discharge from the hospital. DATA SOURCES We searched Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, and PsycINFO. STUDY SELECTION Cohort and case-control studies that compared HSU (admissions, emergency department visits, etc) between late-preterm infants and term infants were included. DATA EXTRACTION Data extracted included study design, setting, population, HSU, covariates, and effect estimates. RESULTS Fifty-two articles were included (50 cohort and 2 case-control studies). Meta-analyses with random effect models that used the inverse-variance method found that late-preterm infants had higher chances of all-cause admissions than term infants during all the time periods. The magnitude of the differences decreased with age from the neonatal period through adolescence, with adjusted odds ratios from 2.34 (95% confidence intervals 1.19-4.61) to 1.09 (1.05-1.13) and adjusted incidence rate ratios from 2.62 (2.52-2.72) to 1.14 (1.11-1.18). Late-preterm infants had higher rates of various cause-specific HSU than term infants for jaundice, infection, respiratory problems, asthma, and neurologic and/or mental health problems during certain periods, including adulthood. LIMITATIONS Considerable heterogeneity existed and was partially explained by the variations in the adjustment for multiple births and gestational age ranges of the term infants. CONCLUSIONS Late-preterm infants had higher risks for all-cause admissions as well as for various cause-specific HSU during the neonatal period through adolescence.
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Affiliation(s)
- Tetsuya Isayama
- Departments of Health Research Methods, Evidence, and Impact, .,Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; and
| | | | - Daria O'Reilly
- Departments of Health Research Methods, Evidence, and Impact.,Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Joseph Beyene
- Departments of Health Research Methods, Evidence, and Impact
| | - Sarah D McDonald
- Departments of Health Research Methods, Evidence, and Impact.,Obstetrics and Gynecology, and.,Radiology, McMaster University, Hamilton, Ontario, Canada
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Valencia AM, Cai CL, Tan J, Duggan TJ, Valencia GB, Aranda JV, Beharry KD. Intravitreal bevacizumab alters type IV collagenases and exacerbates arrested alveologenesis in the neonatal rat lungs. Exp Lung Res 2017; 43:120-133. [PMID: 28409646 DOI: 10.1080/01902148.2017.1306897] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Purpose/Aim: Intravitreal bevacizumab (Avastin) is an irreversible vascular endothelial growth factor (VEGF) inhibitor used off-label to treat severe retinopathy of prematurity in extremely low gestational age neonates. VEGF and matrix metalloproteinases (MMPs) and the tissue inhibitors of metalloproteinases (TIMPs) participate in lung maturation. We tested the hypothesis that intravitreal bevacizumab enters the systemic circulation and has long-lasting effects on lung MMPs. MATERIALS AND METHODS Neonatal rats were exposed to: (1) hyperoxia (50% O2); (2) intermittent hypoxia (IH) (50% O2 with brief episodes of 12% O2); or (3) room air (RA) from birth (P0) to P14. At P14, the time of eye opening in rats, a single dose of Avastin (0.125 mg) was injected into the vitreous cavity of the left eye. A control group received equivalent volume saline. At P23 and P45, lung MMP-2 and MMP-9, and TIMP-1, and TIMP-2 were assessed in the lungs. RESULTS At P23, Avastin increased MMP-2, MMP-9, and TIMP-1 levels in the hyperoxia group but decreased TIMP-1 levels in the IH group. The ratios of MMP-2/TIMP-1 and MMP-9/TIMP-1 were significantly elevated at P23 in the IH group treated with Avastin. At P45, the levels of MMP-2 and MMP-9 remained elevated in the hyperoxia and IH groups treated with Avastin, while a rebound increase in TIMP-1 levels was noted in the IH group. CONCLUSIONS Avastin treatment in IH has lasting alterations in the balance between MMPs and their tissue inhibitors. These changes may lead to impaired alveologenesis and tissue damage consistent with bronchopulmonary dysplasia/chronic lung disease.
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Affiliation(s)
- Arwin M Valencia
- a Department of Pediatrics, Division of Neonatal-Perinatal Medicine , State University of New York, Downstate Medical Center , Brooklyn , New York , USA.,b Department of Pediatrics, Division of Neonatal-Perinatal Medicine , Sumerlin Hospital Medical Center, Valley Healthcare System , Las Vegas , Nevada , USA
| | - Charles L Cai
- a Department of Pediatrics, Division of Neonatal-Perinatal Medicine , State University of New York, Downstate Medical Center , Brooklyn , New York , USA
| | - Jeffrey Tan
- c Department of Ophthalmology , State University of New York, Downstate Medical Center , Brooklyn, New York , USA.,d SUNY Eye Institute , New York , New York , USA
| | - Thomas J Duggan
- a Department of Pediatrics, Division of Neonatal-Perinatal Medicine , State University of New York, Downstate Medical Center , Brooklyn , New York , USA
| | - Gloria B Valencia
- a Department of Pediatrics, Division of Neonatal-Perinatal Medicine , State University of New York, Downstate Medical Center , Brooklyn , New York , USA
| | - Jacob V Aranda
- a Department of Pediatrics, Division of Neonatal-Perinatal Medicine , State University of New York, Downstate Medical Center , Brooklyn , New York , USA.,c Department of Ophthalmology , State University of New York, Downstate Medical Center , Brooklyn, New York , USA.,d SUNY Eye Institute , New York , New York , USA
| | - Kay D Beharry
- a Department of Pediatrics, Division of Neonatal-Perinatal Medicine , State University of New York, Downstate Medical Center , Brooklyn , New York , USA.,c Department of Ophthalmology , State University of New York, Downstate Medical Center , Brooklyn, New York , USA.,d SUNY Eye Institute , New York , New York , USA
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Martinez de Tejada B. Maternal sepsis complicating arabin cervical pessary placement for the prevention of preterm birth: a case report. BMC Pregnancy Childbirth 2017; 17:34. [PMID: 28095812 PMCID: PMC5240248 DOI: 10.1186/s12884-016-1209-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 12/28/2016] [Indexed: 11/10/2022] Open
Abstract
Background Preterm delivery is a major health problem and contributes to more than 50% of all neonatal and infant deaths. Recently, there has been a renewed interest in the use of cervical pessaries as a safe and effective intervention with few maternal side-effects for the prevention of preterm birth in both single and twin pregnancies. Case presentation A 43-year-old gravida 5, para 1 (previous preterm birth at 24 weeks) patient with an in vitro fertilization twin pregnancy had an Arabin cervical pessary placed at 19 weeks of pregnancy due to the presence of cervical funneling identified by ultrasound screening. She developed chorioamnionitis and sepsis and delivered at 21 3/7 weeks after extraction of the pessary. Conclusion Severe maternal infection may complicate pessary treatment for the prevention of preterm birth. Careful follow-up is necessary in women with a cervical pessary during pregnancy, particularly when important funneling is present.
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Affiliation(s)
- Begoña Martinez de Tejada
- Obstetrics Unit, Department of Obstetrics and Gynecology, Geneva University Hospitals and Faculty of Medicine, 30 Boulevard de la Cluse, 1205, Geneva, Switzerland.
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Ronkainen E, Kaukola T, Marttila R, Hallman M, Dunder T. School-age children enjoyed good respiratory health and fewer allergies despite having lung disease after preterm birth. Acta Paediatr 2016; 105:1298-1304. [PMID: 27411109 DOI: 10.1111/apa.13526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/18/2016] [Accepted: 07/11/2016] [Indexed: 01/05/2023]
Abstract
AIM This study explored the under-researched area of whether preterm birth or bronchopulmonary dysplasia (BPD) affected hospitalisation rates, allergies or health-related quality of life (HRQoL). METHODS We studied 88 schoolchildren born preterm at a mean gestational age of 28.8 weeks (range 24.1-31.9) and matched term-born controls at the mean age of 11 years (range 8-14). Hospitalisations after the first discharge were recorded, skin prick allergy tests were performed and HRQoL was assessed with a parental questionnaire. RESULTS Preterm children were hospitalised more than controls (64% versus 39%, p = 0.001), mostly before two years of age. The adjusted odds ratios (OR) for two-year-old preterm-born children being hospitalised for wheezing was 8.2 (95% CI 2.0-34.1). BPD affected 56% of the preterm children, but did not influence hospitalisations, and the positive skin prick rate was similar between the preterm and term-born children (35% versus 48%, p = 0.126). Preterm BPD children had fewer positive skin prick tests than those without BPD. HRQoL was lower in preterm than term children (81.25 ± 10.84 versus 86.80 ± 9.60, p = 0.001). CONCLUSION Most health problems experienced by preterm-born schoolchildren occurred before two years of age and were mainly wheezing disorders. BPD decreased atopy but had no influence on hospitalisation rates.
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Affiliation(s)
- Eveliina Ronkainen
- PEDEGO Research Unit; Medical Research Center Oulu and Department of Children and Adolescents; Oulu University Hospital and University of Oulu; Oulu Finland
| | - Tuula Kaukola
- Division of Neonatal Medicine; Department of Children and Adolescents; Oulu University Hospital; Oulu Finland
| | - Riitta Marttila
- Division of Neonatal Medicine; Department of Children and Adolescents; Oulu University Hospital; Oulu Finland
| | - Mikko Hallman
- PEDEGO Research Unit; Medical Research Center Oulu and Department of Children and Adolescents; Oulu University Hospital and University of Oulu; Oulu Finland
- Division of Neonatal Medicine; Department of Children and Adolescents; Oulu University Hospital; Oulu Finland
| | - Teija Dunder
- Division of Allergology and Pulmonology; Department of Children and Adolescents; Oulu University Hospital; Oulu Finland
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Survival, Hospitalization, and Acute-Care Costs of Very and Moderate Preterm Infants in the First 6 Years of Life: A Population-Based Study. J Pediatr 2016; 169:61-8.e3. [PMID: 26561378 DOI: 10.1016/j.jpeds.2015.10.028] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/22/2015] [Accepted: 10/07/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To investigate survival, hospitalization, and acute-care costs of very (28-31 weeks' gestation) and moderate preterm (32-33 weeks' gestation) infants in the first 6 years of life and compare outcomes with the more widely studied extremely preterm infants (24-27 weeks' gestation) and to full term (low risk) infants (39-40 weeks' gestation). STUDY DESIGN Birth data from all women residing in New South Wales, Australia, with gestational ages between 24-33 and 39-40 weeks in 2001-2011 were linked probabilistically to hospitalization and mortality data. Study outcomes were evaluated with the use of descriptive and multivariable analyses at birth (N = 559,532), discharge (N = 540,240), and at 1 (N = 487,447) and 6 years of age (N = 230,498). RESULTS Mortality was greatest among extremely preterm infants (eg, 31.2% within 6 years) and decreased with increasing gestational age. Likewise, hospitalization within the first year of life increased with decreasing gestational age (aOR 5.5 [95% CI 4.7-6.4], 3.7 [3.4-4.0], and 2.6 [2.5-2.8] for birth at 24-27, 28-31, and 32-33 weeks' gestation, relative to 39-40 weeks' gestation). Hospitalization remained significantly increased with preterm birth at each year of age up to 6 years (aORs 1.3-1.6 at 6 years). Cumulative costs were significantly greater with preterm birth within the first year of life, and also between 1 and 6 years of age. CONCLUSIONS The risks of adverse health outcomes were significantly greater in very and moderately preterm infants relative to full term infants but lower than extremely preterm infants. Crucially, preterm birth was associated with prolonged increased odds of hospitalization (up to age 6 years), contributing to greater resource use.
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Jimenez J, Richter J, Toelen J, Deprest J. Prenatal interventions to prevent bronchopulmonary dysplasia in animal models: a systematic review. J Matern Fetal Neonatal Med 2015; 29:2555-62. [PMID: 26456571 DOI: 10.3109/14767058.2015.1094789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective of this study is to identify and systematically review in vivo animal studies on antenatal medical interventions to prevent bronchopulmonary dysplasia. METHODS An automated literature search was conducted using MEDLINE (Pubmed) and Embase including all studies using Medical Subject Headings (MeSH) and keywords following a step-by-step approach. All in vivo prenatal intervention studies in animal models mimicking key aspects of the pathophysiology of bronchopulmonary dysplasia were included. In view of relevance of the findings, an additional criterion was that outcomes at 48 h of life or beyond were available. The PRISMA statement concerning systemic reviews was applied and a quality checklist developed by the CAMARADES group was used. RESULTS In total, 518 abstracts were identified yet only eight studies were eligible for further analysis. Four studies involved administration of glucocorticoids, the other studies described therapy with epidermal growth factor, interleukin 1b, beta-naphthoflavone, or vitamin D. Outcomes were survival, pulmonary histology, lung function, and/or biochemical analysis. CONCLUSIONS Though many in vivo experimental studies in animal models for bronchopulmonary dysplasia have been done, only few have looked into the effect of prenatal interventions and measured outcomes after at least 48 h of life. Most involve the use of antenatal glucocorticoids, although still only four.
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Affiliation(s)
- Julio Jimenez
- a Cluster Organ Systems, Department of Development and Regeneration, Group Biomedical Sciences, KU Leuven , Leuven , Belgium .,b Department of Obstetrics and Gynaecology , Clínica Alemana , Santiago , Chile
| | - Jute Richter
- a Cluster Organ Systems, Department of Development and Regeneration, Group Biomedical Sciences, KU Leuven , Leuven , Belgium .,c Department of Obstetrics and Gynaecology , University Hospitals KU Leuven , Leuven , Belgium
| | - Jaan Toelen
- a Cluster Organ Systems, Department of Development and Regeneration, Group Biomedical Sciences, KU Leuven , Leuven , Belgium .,d Department of Paediatrics , University Hospitals KU Leuven , Leuven , Belgium , and
| | - Jan Deprest
- a Cluster Organ Systems, Department of Development and Regeneration, Group Biomedical Sciences, KU Leuven , Leuven , Belgium .,c Department of Obstetrics and Gynaecology , University Hospitals KU Leuven , Leuven , Belgium .,e University College London Hospital, Institute for Woman's Health and Great Ormond Street Hospital , London
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Martinez S, Garcia-Meric P, Millet V, Aymeric-Ponsonnet M, Alagha K, Dubus JC. Tobacco smoke in infants with bronchopulmonary dysplasia. Eur J Pediatr 2015; 174:943-8. [PMID: 25633581 DOI: 10.1007/s00431-015-2491-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/06/2015] [Accepted: 01/13/2015] [Indexed: 11/30/2022]
Abstract
UNLABELLED Exposure to tobacco smoke has been not evaluated in children with bronchopulmonary dysplasia (BPD). We evaluate the association of in utero smoking (IUS) and environmental tobacco smoke (ETS) with the respiratory events of BPD and non-BPD children. Two hundred sixty-two children born before 35 weeks of gestational age (GA) and regularly followed up in our regional network for preterms were enrolled. They were paired according to their BPD status, their gestational age and birth weight (131 children with BPD and 131 without BPD, 28 mean weeks GA; mean weight 1000 g). Respiratory data were obtained prospectively during their first 2 years of life. A complementary questionnaire was completed by the parents about their child's respiratory health at the age of 2, their home environment, and tobacco status. IUS concerned 12.6 %; ETS, 48.8 % (67 % in BPD children treated with oxygen at home). No further influence on respiratory outcome could be found by exposure to intrauterine smoke or extrauterine tobacco smoke in this patient sample. CONCLUSION IUS and ETS exposures are as high in preterm children as in a general pediatric population. The highest exposure occurs among BPD infants treated with oxygen at home. WHAT IS KNOWN • Environmental tobacco smoke (ETS) and in utero smoking (IUS) are responsible for many morphological, functional, and clinical changes in children. • Children with bronchopulmonary dysplasia (BPD) have more respiratory events in their first years of life than preterm children without BPB, maybe triggered by ETS and IUS. What is New: • The exposition to ETS and IUS is high in preterm children with and without BDP, as high as in a general. • Pedaitric population, particularly in children with BPD and treated with oxygen at home. • No further influence on respiratory outcome could be found by exposure to ETS or IUS in our studied population.
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Affiliation(s)
- Stéphanie Martinez
- Unité de pneumologie infantile, CHU Timone-Enfants, 264 rue Saint Pierre, 13385, Marseille CEDEX 5, France,
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Bastani F, Abadi TA, Haghani H. Effect of Family-centered Care on Improving Parental Satisfaction and Reducing Readmission among Premature Infants: A Randomized Controlled Trial. J Clin Diagn Res 2015; 9:SC04-8. [PMID: 25738051 PMCID: PMC4347142 DOI: 10.7860/jcdr/2015/10356.5444] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/05/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Healthcare quality is usually evaluated through analysing medical outcomes including neonatal readmission and patient and family satisfaction. Parental involvement in neonatal care is considered as one of the most important factors, which directly affects these outcomes. The aim of the present study was to determine the effect of family-centered care including maternal participation, presence, and information about neonatal care, on maternal satisfaction and neonatal readmission; the care services were provided by the primiparous mothers of preterm infants. MATERIALS AND METHODS One hundred and ten primiparous mothers with preterm infants participated in this clinical trial. All samples were randomly divided into family-centered care (FCC) and control groups, through simple random sampling. The FCC program, which consisted of information about neonatal care, maternal presence, and participation in the care process, was implemented in the FCC group, while the control group was provided with routine care. Data were obtained using demographic and satisfaction questionnaires and readmission checklist. RESULTS In the FCC group, the mean score of satisfaction increased after the implementation of the program (22.36 and 59.28 before and after the program, respectively) (p<0.001); however, this increase in the control group was not significant. The obtained results regarding the different aspects of satisfaction indicated that mothers in the FCC group were more satisfied with maternal presence in the neonatal intensive care unit (NICU), compared with aspects of information and participation. In addition, the number of neonatal readmission was less in the FCC group compared with the control group, and the mean duration of hospitalization was 6.96 and 12.96 days in the FCC and control groups, respectively (p<0.001). CONCLUSION FCC program seems to be effective in increasing maternal satisfaction and decreasing neonatal readmission. Therefore, it seems necessary that healthcare authorities of the departments of obstetrics and gynecology in Iran provide the opportunity for the implementation of such programs in clinical environments, which follow the policy of parental absence and participation in the intensive care units.
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Affiliation(s)
- Farideh Bastani
- Associate Professor, Departments of Community Health Nursing and Geriatrics Nursing, School of Management and Information, Iran University of Medical Sciences, Tehran, Iran
| | - Tayebe Ali Abadi
- Faculty, Department of Nursing, Neyshabur Science and Research Branch, Islamic Azad University, Neyshabur, Iran
| | - Hamid Haghani
- Assistant Professor, Department of Biostatistics, School of Management and Information, Iran University of Medical Sciences, Tehran, Iran
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Doyle LW, Anderson PJ, Battin M, Bowen JR, Brown N, Callanan C, Campbell C, Chandler S, Cheong J, Darlow B, Davis PG, DePaoli T, French N, McPhee A, Morris S, O’Callaghan M, Rieger I, Roberts G, Spittle AJ, Wolke D, Woodward LJ. Long term follow up of high risk children: who, why and how? BMC Pediatr 2014; 14:279. [PMID: 25399544 PMCID: PMC4289257 DOI: 10.1186/1471-2431-14-279] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 10/15/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Most babies are born healthy and grow and develop normally through childhood. There are, however, clearly identifiable high-risk groups of survivors, such as those born preterm or with ill-health, who are destined to have higher than expected rates of health or developmental problems, and for whom more structured and specialised follow-up programs are warranted. DISCUSSION This paper presents the results of a two-day workshop held in Melbourne, Australia, to discuss neonatal populations in need of more structured follow-up and why, in addition to how, such a follow-up programme might be structured. Issues discussed included the ages of follow-up, and the personnel and assessment tools that might be required. Challenges for translating results into both clinical practice and research were identified. Further issues covered included information sharing, best practice for families and research gaps. SUMMARY A substantial minority of high-risk children has long-term medical, developmental and psychological adverse outcomes and will consume extensive health and education services as they grow older. Early intervention to prevent adverse outcomes and the effective integration of services once problems are identified may reduce the prevalence and severity of certain outcomes, and will contribute to an efficient and effective use of health resources. The shared long-term goal for families and professionals is to work toward ensuring that high risk children maximise their potential and become productive and valued members of society.
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Affiliation(s)
- Lex W Doyle
- />Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria Australia
- />Department of Paediatrics, The University of Melbourne, Melbourne, Victoria Australia
- />Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria Australia
- />Premature Infant Follow-up Program, The Royal Women’s Hospital, Parkville, Victoria Australia
- />Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, 20 Flemington Road, Parkville, Victoria 3052 Australia
| | - Peter J Anderson
- />Department of Paediatrics, The University of Melbourne, Melbourne, Victoria Australia
- />Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria Australia
- />Premature Infant Follow-up Program, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Malcolm Battin
- />National Women’s Hospital, Auckland City Hospital, Auckland, New Zealand
| | - Jennifer R Bowen
- />Department of Neonatology, Royal North Shore Hospital, Sydney, New South Wales Australia
| | - Nisha Brown
- />Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria Australia
- />Department of Paediatrics, The University of Melbourne, Melbourne, Victoria Australia
- />Newborn Services, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Catherine Callanan
- />Premature Infant Follow-up Program, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Catherine Campbell
- />Neonatal Paediatrics, King Edward Memorial Hospital, Perth, Western Australia Australia
| | - Samantha Chandler
- />Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, 20 Flemington Road, Parkville, Victoria 3052 Australia
| | - Jeanie Cheong
- />Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria Australia
- />Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria Australia
- />Premature Infant Follow-up Program, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Brian Darlow
- />Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Peter G Davis
- />Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria Australia
- />Premature Infant Follow-up Program, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Tony DePaoli
- />Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania Australia
| | - Noel French
- />Neonatal Paediatrics, King Edward Memorial Hospital, Perth, Western Australia Australia
| | - Andy McPhee
- />Neonatal Services, Women’s and Children’s Health Network, North Adelaide, South Australia Australia
| | - Shusannah Morris
- />Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, 20 Flemington Road, Parkville, Victoria 3052 Australia
| | - Michael O’Callaghan
- />Paediatrics and Child Health, Mater Clinical School, University of Queensland, Brisbane, Queensland Australia
| | - Ingrid Rieger
- />Department of Neonatal Medicine, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales Australia
- />Faculty of Medicine, University of Sydney, Sydney, New South Wales Australia
| | - Gehan Roberts
- />Department of Paediatrics, The University of Melbourne, Melbourne, Victoria Australia
- />Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria Australia
- />Community Child Health, The Royal Children’s Hospital, Parkville, Victoria Australia
| | - Alicia J Spittle
- />Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria Australia
- />Department of Physiotherapy, The University of Melbourne, Parkville, Victoria Australia
| | - Dieter Wolke
- />Department of Psychology, The University of Warwick, Coventry, UK
| | - Lianne J Woodward
- />Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
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Pavey AR, Gorman GH, Kuehn D, Stokes TA, Hisle-Gorman E. Intimate partner violence increases adverse outcomes at birth and in early infancy. J Pediatr 2014; 165:1034-9. [PMID: 25128162 DOI: 10.1016/j.jpeds.2014.06.060] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 05/27/2014] [Accepted: 06/26/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the effect of intimate partner violence (IPV) on birth outcomes and infant hospitalization. STUDY DESIGN Hospitalization records for the first 4 months of life for infants born in the Military Health System in 2006-2007 were linked to Family Advocacy Program-substantiated cases of IPV among military parents. Adverse outcomes were identified using International Classification of Diseases, Ninth Revision codes. Logistic regression modeling calculated the OR of children exposed to IPV experiencing adverse outcomes. RESULTS A total of 204,546 infants were born during the study period. Among these, 173,026 infants (85%) were linked to active duty military parents. 31,603 infants (18%) experienced adverse outcomes, and 3059 infants (1.8%) were born into families with IPV. The infants exposed to IPV had a 31% increased odds of experiencing adverse outcomes compared with infants without known IPV exposure. IPV exposure increased the odds of the following outcomes: prematurity (OR, 1.45; 95% CI, 1.29-1.62), low birth weight (OR, 1.57; 95% CI, 1.25-1.97), respiratory problems (OR, 1.17; 95% CI, 1.04-1.32), neonatal hospitalization (OR, 1.39; 95% CI, 1.20-1.61), and postneonatal hospitalization (OR, 1.52; 95% CI, 1.29-1.81). After controlling for prematurity and demographic variables, IPV exposure was associated with low birth weight (OR, 1.52; 95% CI, 1.16-1.99), neonatal hospitalization (OR, 1.24; 95% CI, 1.02-1.49), and postneonatal hospitalization (OR, 1.27; 95% CI, 1.03-1.56). CONCLUSION Infants exposed to IPV are more likely to experience adverse birth outcomes and infant hospitalization. Routinely addressing IPV during prenatal and early pediatric visits may potentially prevent these adverse outcomes.
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Affiliation(s)
- Ashleigh R Pavey
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD.
| | - Gregory H Gorman
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Pediatrics, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Devon Kuehn
- Department of Pediatrics, Uniformed Services University of Health Sciences, Bethesda, MD; Department of Pediatrics, Womack Army Medical Center, Fort Bragg, NC
| | - Theophil A Stokes
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Pediatrics, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Elizabeth Hisle-Gorman
- Department of Pediatrics, Uniformed Services University of Health Sciences, Bethesda, MD
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Strunk T, Inder T, Wang X, Burgner D, Mallard C, Levy O. Infection-induced inflammation and cerebral injury in preterm infants. THE LANCET. INFECTIOUS DISEASES 2014; 14:751-762. [PMID: 24877996 DOI: 10.1016/s1473-3099(14)70710-8] [Citation(s) in RCA: 200] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Preterm birth and infectious diseases are the most common causes of neonatal and early childhood deaths worldwide. The rates of preterm birth have increased over recent decades and account for 11% of all births worldwide. Preterm infants are at significant risk of severe infection in early life and throughout childhood. Bacteraemia, inflammation, or both during the neonatal period in preterm infants is associated with adverse outcomes, including death, chronic lung disease, and neurodevelopmental impairment. Recent studies suggest that bacteraemia could trigger cerebral injury even without penetration of viable bacteria into the CNS. Here we review available evidence that supports the concept of a strong association between bacteraemia, inflammation, and cerebral injury in preterm infants, with an emphasis on the underlying biological mechanisms, clinical correlates, and translational opportunities.
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Affiliation(s)
- Tobias Strunk
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia; Neonatal Clinical Care Unit, King Edward Memorial Hospital, Perth, WA, Australia.
| | - Terrie Inder
- Department of Pediatrics, Neurology and Radiology, Washington University, St Louis, USA
| | - Xiaoyang Wang
- Perinatal Center, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Pediatrics, The Third Affiliated Hospital of Zhengzhou University, Shangjie, Henan, China
| | - David Burgner
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Carina Mallard
- Perinatal Center, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ofer Levy
- Department of Medicine, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Gibson AM, Doyle LW. Respiratory outcomes for the tiniest or most immature infants. Semin Fetal Neonatal Med 2014; 19:105-11. [PMID: 24239022 DOI: 10.1016/j.siny.2013.10.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Extremely low birth weight (<1000 g birth weight) or extremely preterm (<28 weeks of gestation) infants are surviving in greater numbers as neonatal care advances. Many of these survivors, especially those who develop bronchopulmonary dysplasia, have more respiratory ill health in the first years after discharge home, reduced respiratory function and impaired exercise capacity throughout childhood and into adulthood compared with term-born controls. It is important to establish the long-term respiratory outcomes for the tiniest or most immature survivors as they grow older, since they may contribute disproportionately to rates of chronic obstructive pulmonary disease and respiratory ill-health in adulthood.
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Affiliation(s)
- Anne-Marie Gibson
- Respiratory Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Lex W Doyle
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, Victoria, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
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Roberts G, Cheong JLY. Long-term growth and general health for the tiniest or most immature infants. Semin Fetal Neonatal Med 2014; 19:118-24. [PMID: 24289903 DOI: 10.1016/j.siny.2013.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Given the improving survival rates of extremely preterm (EP, gestational age <28 weeks) infants, there is a need to understand their general growth and health outcomes not only in childhood, but also into adulthood. EP children are shorter and lighter compared with term children at term-equivalent age; with time, the weight disadvantage diminishes but the height disadvantage remains relatively unchanged. EP children and young adults also have higher rates of reported health concerns, medical conditions and visual impairment. Hospital readmissions are higher in early childhood, mostly attributed to respiratory illness. Individuals born EP have reduced bone health and are at increased risk for metabolic disorders. Increased rates of conditions such as diabetes or pathological fractures are not reported in the literature, although follow-up studies so far have only tracked EP individuals into young adulthood. Consequently, health care utilization and costs are increased in EP children and young adults. A thorough knowledge of the health risks related to EP birth is essential in planning surveillance and intervention strategies to optimize their health and wellbeing. Despite the increased risk of health problems, EP young adults generally report their quality of life to be similar to that reported in their term counterparts.
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Affiliation(s)
- Gehan Roberts
- Premature Infant Follow-up Program at the Royal Women's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia.
| | - Jeanie L Y Cheong
- Premature Infant Follow-up Program at the Royal Women's Hospital, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
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Tsopanoglou SP, Davidson J, Goulart AL, Barros MCDM, dos Santos AMN. Functional capacity during exercise in very-low-birth-weight premature children. Pediatr Pulmonol 2014; 49:91-8. [PMID: 23359551 DOI: 10.1002/ppul.22754] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Accepted: 11/08/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The functional capacity of children born prematurely with very-low-birth weight was compared with that of children born at full-term using the six-minute walk test (6MWT) and the ten-minutes shuttle walk test (10MSWT). The factors affecting walking distance were analyzed. METHODS A cross-sectional study was conducted with two groups of children aged 6-9 years, matched by sex and age. One group included children born before 37 weeks of gestation weighing <1,500 g and the second group included children born at term. Both groups were submitted to the 6MWT and 10MWST, performed on the same day with an interval of 20 min between tests and the sequence of the tests was randomized, by sealed-envelope technique. Physiological parameters were measured at the beginning and end of each test. The walking distance and factors affecting the walking distance were analyzed. RESULTS Thirty-seven children born prematurely and 37 born at term were studied. The premature children walked shorter distances in the 6MWT (480.9 ± 80.5 m vs. 518.3 ± 51.8 m, P = 0.010) than term children, and both groups walked similar distances in the 10MSWT (391.5 ± 99.0 m vs. 406.1 ± 79.2 m, P = 0.487). By multiple linear regression analysis, adjusted for confounders, walking distance was associated with height (OR: 3.6) and oxygen dependency at 28 days (OR: -67.7) in the 6MWT (P < 0.001) and with height (OR: 4.9) and oxygen dependency at 28 days (OR: -91.0) in the 10MSWT (P < 0.001). CONCLUSION In conclusion, this study suggests that children born prematurely with very low birth weight, especially those who had bronchopulmonary dysplasia present limited functional capacity during exercise.
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Blencowe H, Cousens S, Chou D, Oestergaard M, Say L, Moller AB, Kinney M, Lawn J. Born too soon: the global epidemiology of 15 million preterm births. Reprod Health 2013; 10 Suppl 1:S2. [PMID: 24625129 PMCID: PMC3828585 DOI: 10.1186/1742-4755-10-s1-s2] [Citation(s) in RCA: 1283] [Impact Index Per Article: 116.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
This second paper in the Born Too Soon supplement presents a review of the epidemiology of preterm birth, and its burden globally, including priorities for action to improve the data. Worldwide an estimated 11.1% of all livebirths in 2010 were born preterm (14.9 million babies born before 37 weeks of gestation), with preterm birth rates increasing in most countries with reliable trend data. Direct complications of preterm birth account for one million deaths each year, and preterm birth is a risk factor in over 50% of all neonatal deaths. In addition, preterm birth can result in a range of long-term complications in survivors, with the frequency and severity of adverse outcomes rising with decreasing gestational age and decreasing quality of care. The economic costs of preterm birth are large in terms of immediate neonatal intensive care, ongoing long-term complex health needs, as well as lost economic productivity. Preterm birth is a syndrome with a variety of causes and underlying factors usually divided into spontaneous and provider-initiated preterm births. Consistent recording of all pregnancy outcomes, including stillbirths, and standard application of preterm definitions is important in all settings to advance both the understanding and the monitoring of trends. Context specific innovative solutions to prevent preterm birth and hence reduce preterm birth rates all around the world are urgently needed. Strengthened data systems are required to adequately track trends in preterm birth rates and program effectiveness. These efforts must be coupled with action now to implement improved antenatal, obstetric and newborn care to increase survival and reduce disability amongst those born too soon.
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Affiliation(s)
- Hannah Blencowe
- MARCH, London School of Hygiene and Tropical Medicine, London, UK
| | - Simon Cousens
- MARCH, London School of Hygiene and Tropical Medicine, London, UK
| | - Doris Chou
- World Health Organization, Geneva, Switzerland
| | | | - Lale Say
- World Health Organization, Geneva, Switzerland
| | | | - Mary Kinney
- Saving Newborn Lives, Save the Children, Cape Town, South Africa
| | - Joy Lawn
- MARCH, London School of Hygiene and Tropical Medicine, London, UK
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Response of vascular endothelial growth factor and angiogenesis-related genes to stepwise increases in inspired oxygen in neonatal rat lungs. Pediatr Res 2013; 73:630-8. [PMID: 23385964 DOI: 10.1038/pr.2013.21] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Bronchopulmonary dysplasia is an inflammatory lung disease that afflicts preterm infants requiring supplemental oxygen and is associated with impaired pulmonary angiogenesis. We tested the hypothesis that there is a critical threshold of inspired O2 (FiO2) that alters pulmonary angiogenesis. METHODS Within 2-6 h of birth, rat pups were exposed to 10%, 21%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, or 100% FiO2 for 2 h. Mixed arterial-venous blood gases, serum and pulmonary levels of vascular endothelial growth factor (VEGF) and soluble VEGF receptor-1, and pulmonary angiogenesis gene profiles were determined. RESULTS PO2 increased with hyperoxia from 35.6 ± 5.0 (range: 31.5-39.8) at 10% O2 to 108.5 ± 25.0 (range: 82.2-134.8) at 100% O2. PO2 at 21% O2 was 42.4 ± 7.3 (range: 36.8-48.1). Lung VEGF levels declined at 40%-100%. The critical PO2 associated with decreased lung VEGF was 66 mm Hg, achieved with a FiO2 of 0.4. PO2 was inversely correlated with VEGF levels in the lungs (R = -0.377; P < 0.008). Antiangiogenesis genes were robustly upregulated at 70%, predominantly in males. Data are reported as mean ± SD. CONCLUSIONS A critical threshold of FiO2 affecting angiogenesis exists in immature lungs. Exposure of preterm lungs to >40% inspired O2, even for 2 h, may result in abnormal expression of biomarkers regulating lung angiogenesis.
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D'Agostino JA, Gerdes M, Hoffman C, Manning ML, Phalen A, Bernbaum J. Provider use of corrected age during health supervision visits for premature infants. J Pediatr Health Care 2013; 27:172-9. [PMID: 23611457 DOI: 10.1016/j.pedhc.2011.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 08/29/2011] [Accepted: 09/03/2011] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Correcting age for prematurity is recommended by the American Academy of Pediatrics and the Centers for Disease Control and Prevention. The use of chronological age instead of corrected age for infants born prematurely may result in incorrect interpretations regarding the adequacy of a child's growth or developmental progress and has the potential to negatively affect care. This study examined the frequency and impact of the use of corrected age by primary care providers. METHOD A retrospective cross-sectional electronic health record review was performed for all infants < 32 weeks' gestation who were seen for a health supervision visit in a 31-site pediatric network during a 1-year period. Primary care providers used an electronic health record that defaulted to chronological age information. RESULTS Primary care providers used corrected age for developmental surveillance for 24% of visits, they used chronological age for 71% of visits, and the age used was unclear in 5% of visits. The lower a child's gestational age and the more that chronological age was used, the more concerns were identified by primary care providers. Dietary changes that included the introduction of solid foods, the start of fluoride, and the introduction of milk typically were recommended on the basis of chronological age. DISCUSSION Primary care providers used chronological age more than corrected age, which influenced assessment and recommendations for care. This study illustrates the impact of not using corrected age, the importance of ensuring that care aligns with guidelines, and the possible influence of the design of the electronic health record on patient care. Because families of premature infants rely on primary care providers to accurately identify sequelae associated with prematurity, and to provide reassurance when it is warranted, these findings have implications for all health care providers who treat premature infants.
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Affiliation(s)
- Jo Ann D'Agostino
- Department of Pediatrics and Division of GeneralPediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Atwell K, Collins CT, Sullivan TR, Ryan P, Gibson RA, Makrides M, McPhee AJ. Respiratory hospitalisation of infants supplemented with docosahexaenoic acid as preterm neonates. J Paediatr Child Health 2013; 49:E17-22. [PMID: 23279074 DOI: 10.1111/jpc.12057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2012] [Indexed: 11/27/2022]
Abstract
AIM To determine the effect of neonatal docosahexaenoic acid (DHA) supplementation in preterm infants on later respiratory-related hospitalisations. METHODS We enrolled 657 infants in a multicentre, randomised, controlled trial designed to study the long-term efficacy of higher dose dietary DHA in infants born <33 weeks' gestation. Treatment was with high DHA (∼1%) compared with standard DHA (∼0.3%) in breast milk or formula, given from the first week of life to term equivalent. Parent-reported hospital admissions to 18 months corrected age were recorded. The proportion of children hospitalised for lower respiratory tract (LRT) conditions and the mean number of hospitalisations per infant were determined. RESULTS Twenty-three per cent (154/657) of infants were hospitalised for LRT conditions. Seventy-three per cent (173/238) of admissions were for bronchiolitis. There was no significant effect of higher DHA on the proportion of infants admitted for LRT conditions (high DHA 22% vs. standard DHA 25%, adjusted relative risk 0.92, 95% confidence interval (CI) 0.68-1.24, P = 0.57) or in the mean number of admissions per infant (high DHA 0.34, standard DHA 0.38, adjusted ratio of means 0.91, 95% CI 0.63-1.32, P = 0.62). The sexes responded differently to treatment (interaction P = 0.046), with reduced admissions in boys given high DHA, but this was not statistically significant (high DHA 19%, standard DHA 28%, adjusted relative risk 0.69, 95% CI 0.46-1.04, P = 0.08). CONCLUSIONS Hospitalisation for LRT problems in the first 18 months for preterm infants was not reduced by neonatal supplementation with 1% DHA.
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Affiliation(s)
- Kerryn Atwell
- Neonatal Medicine, Women's and Children's Hospital, North Adelaide, South Australia, Australia
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Definition and outpatient management of the very low-birth-weight infant with bronchopulmonary dysplasia. Adv Ther 2012; 29:297-311. [PMID: 22529025 DOI: 10.1007/s12325-012-0015-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Indexed: 12/28/2022]
Abstract
Bronchopulmonary dysplasia (BPD), also known as chronic lung disease of prematurity, is the major cause of pulmonary disease in infants. The pathophysiology and management of BPD have evolved over the past four decades as improved neonatal intensive care unit (NICU) modalities have increased survival rates. The likelihood for developing BPD increases with the degree of prematurity and reaches 25-35% in very low-birth-weight and extremely low-birth-weight infants. BPD affects many organ systems, and infants with BPD are at increased risk for rehospitalization and numerous complications following NICU discharge. The management of BPD and medically related problems, particularly during the first 2 years of life, remains a continuing challenge for parents and healthcare providers. It is important that a multidisciplinary team consisting of the neonatologist/attending physician, primary care physician, and other specialized support staff work in concert and meet regularly to provide continuity of care and accurate patient assessments.
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McGrath-Morrow SA, Ryan T, McGinley BM, Okelo SO, Sterni LM, Collaco JM. Polysomnography in preterm infants and children with chronic lung disease. Pediatr Pulmonol 2012; 47:172-9. [PMID: 21815283 PMCID: PMC4751876 DOI: 10.1002/ppul.21522] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 06/12/2011] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the utility of overnight polysomnography (PSG) in assessing pulmonary reserve in stable preterm children with chronic lung disease (CLD). STUDY DESIGN A retrospective review and descriptive study of overnight PSGs and clinic visits of preterm infants/children less than 3 years of age who were diagnosed with bronchopulmonary dysplasia at discharge from the hospital and enrolled in the Johns Hopkins CLD patient registry between 2008 and 2010. RESULTS Sixty-two clinically stable patients underwent at least one overnight polysomnogram for clinical indications. The majority of patients were referred for oxygen titration (71%). PSGs from first studies revealed a mean respiratory disturbance index (RDI) of 8.2 ± 10.1 events/hr and a mean O(2) saturation (SaO(2) ) nadir of 86.2 ± 5.7%. In patients who underwent more than one PSG (n = 23), a significant decrease in RDI (P < 0.001) was found between the first study (mean age: 8.0 ± 3.3 months) and second study (mean age: 13.4 ± 5.2 months). Outpatient clinical measures of mean room air SaO(2) and respiratory rate were not predictive of PSG measures of RDI and SaO(2) nadir. CONCLUSION Mean RDI was higher in stable preterm infants/children with CLD compared to previously published controls. RDI decreased with age in stable preterm infants/children with CLD suggesting improved pulmonary reserve with age. Outpatient clinical measures (respiratory rate and room air SaO(2) ) did not correlate with RDI and SaO(2) nadir indicating that overnight PSG is more sensitive in assessing pulmonary reserve than outpatient clinical measures.
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Affiliation(s)
- Sharon A McGrath-Morrow
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287-2533, USA.
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Postnatal steroids for the treatment of bronchopulmonary dysplasia: a complex case presentation. J Perinat Neonatal Nurs 2011; 25:283-91; quiz 292-3. [PMID: 21825919 DOI: 10.1097/jpn.0b013e318225995c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Postnatal steroids are a controversial intervention for the prevention and treatment of bronchopulmonary dysplasia in preterm infants. Studies demonstrating a potential for steroid-related adverse effects, including growth and neurodevelopmental impairment, have significantly changed clinical practice over the past decade. There are circumstances in which the potential benefits may outweigh the risks associated with postnatal steroids. This case presentation details the hospital course and treatment plan for an extremely low-birth-weight infant who remained ventilator dependent at the age of 3 weeks. Evidence-based research, American Academy of Pediatric recommendations, and collaboration with the family helped guide the plan of care. Following a short course of low-dose dexamethasone, the infant was successfully extubated. The case highlights the importance of using clinical judgment based on research and family preferences to benefit the patient.
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McGrath-Morrow S. The Transition from Bronchopulmonary Dysplasia to Childhood Chronic Lung Disease. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2011; 24:27-32. [PMID: 35927857 DOI: 10.1089/ped.2011.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The impact of a preterm birth on lung function in later life is not always predictable and the variability of lung phenotype in these children can be striking even among children of the same gestational age. Although many children with a history of bronchopulmonary dysplasia (BPD) improve with age, others continue to manifest significant pulmonary abnormalities. Several different lung phenotypes have been described in older children with a history of BPD. These descriptions have been based in part on chronic respiratory symptoms, pulmonary function abnormalities, and response to respiratory illnesses. These lung phenotypes include large and/or small airway dysfunction, impaired alveolar growth characterized by decreased pulmonary reserve, and pulmonary hypertension found primarily in children with severe chronic lung disease. Children with a history of BPD can manifest 1 or more of these lung phenotypes with varying degrees of severity. Currently, treatment of respiratory symptoms is primarily supportive and symptom based. Although many children improve with age, others continue to have chronic respiratory symptoms into adult life. The development of standardized guidelines for the care of children after discharge from the neonatal intensive care unit may help direct appropriate therapy, limit lung injury, and maximize lung growth potential in this vulnerable group of children.
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Affiliation(s)
- Sharon McGrath-Morrow
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Labree W, Foets M, Weisglas-Kuperus N. Continuity and coordination of care during and after neonatal intensive care. J Child Health Care 2010; 14:239-49. [PMID: 20447948 DOI: 10.1177/1367493509360353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To assess parental experiences regarding the continuity and coordination of care in children suffering from long-lasting health problems during and after treatment at a Neonatal Intensive Care Unit (NICU), a cross-sectional survey was performed, using a validated tool to obtain continuity and coordination scores. Scores were collected among parents of four age groups: newborns at the NICU (n = 51), ex-NICU preschool children (n = 50), ex-NICU children in primary school (n = 53), and ex-NICU children in secondary school (n = 57). Overall, parents are least satisfied with the consistency of care concerning the specific needs of their children. Parents of children in primary school experience most problems, followed by parents of children in secondary school. Furthermore, parents had a positive opinion towards other continuity and coordination aspects. Our findings implicate that regular neonatal follow-up care should not be restricted to the first years of life, but should be extended to both primary school age, and secondary school age. In particular, health care providers have to be attentive to the changing needs of children during their development.
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