1
|
Ribas-Prats T, Arenillas-Alcón S, Martínez SIF, Gómez-Roig MD, Escera C. The frequency-following response in late preterm neonates: a pilot study. Front Psychol 2024; 15:1341171. [PMID: 38784610 PMCID: PMC11112609 DOI: 10.3389/fpsyg.2024.1341171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Infants born very early preterm are at high risk of language delays. However, less is known about the consequences of late prematurity. Hence, the aim of the present study is to characterize the neural encoding of speech sounds in late preterm neonates in comparison with those born at term. Methods The speech-evoked frequency-following response (FFR) was recorded to a consonant-vowel stimulus /da/ in 36 neonates in three different groups: 12 preterm neonates [mean gestational age (GA) 36.05 weeks], 12 "early term neonates" (mean GA 38.3 weeks), and "late term neonates" (mean GA 41.01 weeks). Results From the FFR recordings, a delayed neural response and a weaker stimulus F0 encoding in premature neonates compared to neonates born at term was observed. No differences in the response time onset nor in stimulus F0 encoding were observed between the two groups of neonates born at term. No differences between the three groups were observed in the neural encoding of the stimulus temporal fine structure. Discussion These results highlight alterations in the neural encoding of speech sounds related to prematurity, which were present for the stimulus F0 but not for its temporal fine structure.
Collapse
Affiliation(s)
- Teresa Ribas-Prats
- Brainlab–Cognitive Neuroscience Research Group. Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Sonia Arenillas-Alcón
- Brainlab–Cognitive Neuroscience Research Group. Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Silvia Irene Ferrero Martínez
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- BCNatal–Barcelona Center for Maternal Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic), University of Barcelona, Barcelona, Spain
| | - Maria Dolores Gómez-Roig
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- BCNatal–Barcelona Center for Maternal Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic), University of Barcelona, Barcelona, Spain
| | - Carles Escera
- Brainlab–Cognitive Neuroscience Research Group. Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| |
Collapse
|
2
|
Orton M, Theilen L, Clark E, Baserga M, Lauer S, Ou Z, Presson AP, Dupont T, Katheria A, Singh Y, Chan B. Thermoregulation-Focused Implementation of Delayed Cord Clamping among <34 Weeks' Gestational Age Neonates. Am J Perinatol 2024; 41:e3099-e3106. [PMID: 37989208 DOI: 10.1055/s-0043-1776916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Delayed cord clamping (DCC) is recommended for all neonates; however, adapting such practice can be slow or unsustainable, especially among preterm neonates. During DCC neonates are exposed to a cool environment, raising concerns for neonatal hypothermia. Moderate hypothermia may induce morbidities that counteract the potential benefits of DCC. A quality improvement project on a thermoregulation-focused DCC protocol was implemented for neonates less than 34 weeks' gestational age (GA). The aim was to increase the compliance rate of DCC while maintaining normothermia. STUDY DESIGN The DCC protocol was implemented on October 1, 2020 in a large Level III neonatal intensive care unit. The thermoregulation measures included increasing delivery room temperature and using heat conservation supplies (sterile polyethylene suit, warm towels, and thermal pads). Baseline characteristics, the compliance rate of DCC, and admission temperatures were compared 4 months' preimplementation and 26 months' postimplementation RESULTS: The rate of DCC increased from 20% (11/54) in preimplementation to 57% (240/425) in postimplementation (p < 0.001). The balancing measure of admission normothermia remained unchanged. In a postimplementation subgroup analysis, the DCC cohort had less tendency to experience admission moderate hypothermia (<36°C; 9.2 vs. 14.1%, p = 0.11). The DCC cohort had more favorable secondary outcomes including higher admission hematocrit, less blood transfusions, less intraventricular hemorrhage, and lower mortality. Improving the process measure of accurate documentation could help to identify implementation barriers. CONCLUSION Performing DCC in preterm neonates was feasible and beneficial without increasing admission hypothermia. KEY POINTS · Thermoregulation-focused DCC protocol was implemented to increase DCC while maintaining normothermia.. · DCC rate increased from 20 to 57% while admission normothermia rate remained the same.. · DCC practice on preterm neonates is safe and feasible while maintaining normothermia..
Collapse
Affiliation(s)
- Melissa Orton
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Lauren Theilen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - Erin Clark
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - Mariana Baserga
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Sarah Lauer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - Zhining Ou
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Angela P Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Tara Dupont
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Anup Katheria
- San Diego Neonatology, Department of Pediatrics, Sharp Mary Birch Hospital for Women and Newborn, San Diego, California
- Division of Neonatology, Department of Pediatrics, University of California at San Diego, San Diego, California
| | - Yogen Singh
- Division of Neonatology, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, California
| | - Belinda Chan
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| |
Collapse
|
3
|
Logan JW, Bapat R, Ryshen G, Bagwell G, Eisner M, Kielt M, Hanawalt M, Payne K, Alt-Coan A, Tatad M, Krendl D, Jebbia M, Reber KM, Halling C, Osman AAF, Bonachea EM, Nelin LD, Fathi O. Use of a Quality Scorecard to Enhance Quality and Safety in Community Hospital Newborn Nurseries. J Pediatr 2022; 247:67-73.e2. [PMID: 35358590 DOI: 10.1016/j.jpeds.2022.03.033] [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: 12/16/2021] [Revised: 02/22/2022] [Accepted: 03/10/2022] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To implement a quality improvement (QI) scorecard as a tool for enhancing quality and safety efforts in level 1 and 2 community hospital nurseries affiliated with Nationwide Children's Hospital. STUDY DESIGN A QI scorecard was developed for data collection, analytics, and reporting of neonatal quality metrics and cross-sector collaboration. Newborn characteristics were included for risk stratification, as were clinical and process measures associated with neonatal morbidity and mortality. Quality and safety activities took place in community hospital newborn nurseries in Ohio, and education was provided in both online and in-person collaborations, followed by local team sessions at partner institutions. Baseline (first 12 months) and postbaseline comparisons of clinical and process measures were analyzed by logistic regression, adjusting for potential confounders. RESULTS In logistic regression models, at least 1 center documented improvements in each of the 4 process measures, and 3 of the 4 centers documented improvements in compliance with glucose checks obtained within 90 minutes of birth among at-risk infants. CONCLUSION Collaborative QI projects led to improvements in perinatal metrics associated with important outcomes. Formation of a center-driven QI scorecard is feasible and provides community hospitals with a framework for collecting, analyzing, and reporting neonatal QI metrics.
Collapse
Affiliation(s)
- J Wells Logan
- Department of Pediatrics, University of Florida College of Medicine and Wolfson Children's Hospital, Jacksonville, FL
| | - Roopali Bapat
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Greg Ryshen
- Quality Improvement Services, Nationwide Children's Hospital, Columbus, OH
| | - Gail Bagwell
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Mariah Eisner
- Biostatistics Resource at Nationwide Children's Hospital, Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Matthew Kielt
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Martin Hanawalt
- Pediatric Hospitalist Program, Nationwide Children's Hospital, Ohio Health Mansfield, Mansfield, OH
| | - Kelly Payne
- Pediatric Hospitalist Program, Nationwide Children's Hospital, Ohio Health Mansfield, Mansfield, OH
| | - Amy Alt-Coan
- Pediatric Hospitalist Program, Blanchard Valley Health System, Findlay, OH
| | - Magdalino Tatad
- Pediatric Hospitalist Program, St. Rita's Health System, Lima, OH
| | - Debbie Krendl
- Pediatric Hospitalist Program, St. Rita's Health System, Lima, OH
| | - Maria Jebbia
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Kristina M Reber
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Cecilie Halling
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Ahmed A F Osman
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | | | - Leif D Nelin
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Omid Fathi
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.
| |
Collapse
|
4
|
Gulersen M, Gyamfi-Bannerman C, Greenman M, Lenchner E, Rochelson B, Bornstein E. Practice patterns in the administration of late preterm antenatal corticosteroids. AJOG GLOBAL REPORTS 2021; 1:100014. [PMID: 36277253 PMCID: PMC9563817 DOI: 10.1016/j.xagr.2021.100014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Given the unpredictable nature of preterm birth and the short-term impact of antenatal corticosteroids on neonatal outcomes, optimal timing of antenatal corticosteroid administration (2–7 days from expected birth) remains challenging. OBJECTIVE We set out to evaluate the likelihood of delivery between 2 and 7 days after antenatal corticosteroid administration in the late preterm period and whether this differs based on the indication for corticosteroid administration. STUDY DESIGN Retrospective cohort of all singletons that received antenatal corticosteroids in the late preterm period (34 0/7 to 36 6/7 weeks’ gestation) and delivered within a large health system between November 2017 and March 2020. Women who received antenatal corticosteroids before the late preterm period, major fetal structural malformations, and cases with missing data were excluded. Cases were stratified on the basis of the indication for antenatal corticosteroid administration, that is, anticipated spontaneous late preterm birth or medically indicated late preterm birth. The primary outcome was delivery between 2 and 7 days after the administration of the first dose of antenatal corticosteroids. Secondary outcomes included time interval from antenatal corticosteroid administration to delivery and delivery during the first 2 days or later than 7 days after antenatal corticosteroid administration. Multivariable logistic regression was performed to evaluate factors associated with optimal timing while adjusting for potential confounders. RESULTS Of the 1238 patients included in the study, 656 (53%) delivered within the first day after antenatal corticosteroid administration and thus received only the first of 2 doses. Regardless of the indication for late preterm antenatal corticosteroid administration, the likelihood of delivery between 2 and 7 days later was 13.3% (165 of 1238). Moreover, it was more common (23.4% vs 5.0%; P≤.001) (Table 2) and more likely (adjusted odds ratio, 5.88; 95% confidence interval, 4.00–9.09) in women at risk of medically indicated preterm birth than in those with anticipated spontaneous preterm birth. Furthermore, women with anticipated spontaneous preterm birth had a shorter time interval from antenatal corticosteroid administration to delivery (10.7 vs 49.71 hour; P≤.001). CONCLUSION Regardless of the indication for late preterm antenatal corticosteroid administration, the likelihood of delivery between 2 and 7 days later was low. Nevertheless, our data suggested that delivery within the desired time interval of antenatal corticosteroid administration is more common in women at risk of medically indicated late preterm birth compared with those at risk of spontaneous late preterm birth.
Collapse
|
5
|
Gulersen M, Gyamfi-Bannerman C, Greenman M, Lenchner E, Rochelson B, Bornstein E. Time interval from late preterm antenatal corticosteroid administration to delivery and the impact on neonatal outcomes. Am J Obstet Gynecol MFM 2021; 3:100426. [PMID: 34153514 DOI: 10.1016/j.ajogmf.2021.100426] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/30/2021] [Accepted: 06/15/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although administration of antenatal corticosteroids has been shown to decrease neonatal respiratory morbidity when given to women at risk for late preterm birth, the time interval from antenatal corticosteroid administration to delivery that is associated with the greatest neonatal benefit remains unknown. OBJECTIVE This study aimed to evaluate whether the time interval from administration of late preterm antenatal corticosteroids to delivery is associated with a change in the likelihood of transient tachypnea of the newborn, respiratory distress syndrome, and hypoglycemia. STUDY DESIGN This was a retrospective cohort study of all singleton neonates who were exposed to 1 or 2 doses of antenatal corticosteroids in the late preterm period (34+0 to 36+6 weeks' gestation) within a large healthcare system between November 2017 and March 2020. Neonates exposed to antenatal corticosteroids before 34 weeks' gestation and those with major fetal structural malformations and chromosomal disorders were excluded. Cases were stratified into the following groups based on the time interval from the first dose of antenatal corticosteroid administration to delivery: <2 days, 2 to 7 days, and >7 days. The primary outcome of transient tachypnea of the newborn was compared among the 3 groups. Secondary outcomes included respiratory distress syndrome and hypoglycemia. A multivariable logistic regression was performed to evaluate the association between the time interval and neonatal outcomes while adjusting for potential confounders. For each outcome, delivery within 2 to 7 days from the first dose of betamethasone administration was defined as the reference group. Data were presented as adjusted odds ratios with 95% confidence intervals, and statistical significance was defined as P < .05. RESULTS The study cohort comprised 1248 neonates. Of those, 649 (52%) were exposed to 1 dose of antenatal corticosteroids. There were statistically significant differences in the maternal characteristics such as nulliparity, pregnancies complicated by hypertensive disorders and fetal growth restriction, gestational age at antenatal corticosteroid administration, gestational age at delivery, and mode of delivery among the 3 groups. There was a significantly increased risk for transient tachypnea of the newborn (adjusted odds ratio, 4.81; 95% confidence interval, 1.72-12.92) and respiratory distress syndrome (adjusted odds ratio, 9.86; 95% confidence interval, 1.15-84.24) associated with delivery <2 days of antenatal corticosteroid administration. The risk for hypoglycemia was highest in the delivery <2 days group (adjusted odds ratio, 3.44; 95% confidence interval, 2.10-5.63) and decreased as the time interval from antenatal corticosteroid administration to delivery increased (adjusted odds ratio, 0.32; 95% confidence interval, 0.20-0.51 for delivery >7 days). CONCLUSION Adverse neonatal outcomes such as transient tachypnea of the newborn, respiratory distress syndrome, and hypoglycemia are more common when late preterm birth occurs <2 days after antenatal corticosteroid administration when compared with birth 2 to 7 days after administration. In addition, delivery >7 days after antenatal corticosteroid administration is associated with a decreased risk for hypoglycemia. Understanding the impact of antenatal corticosteroid timing on neonatal outcomes is essential in caring for patients at risk for late preterm birth.
Collapse
Affiliation(s)
- Moti Gulersen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY (Drs Gulersen, Greenman, and Rochelson); Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA (Dr Gyamfi-Bannerman); Biostatistics and Data Management, New York University Rory Meyers College of Nursing, New York, NY (Dr Lenchner); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, NY (Dr Bornstein).
| | - Cynthia Gyamfi-Bannerman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY (Drs Gulersen, Greenman, and Rochelson); Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA (Dr Gyamfi-Bannerman); Biostatistics and Data Management, New York University Rory Meyers College of Nursing, New York, NY (Dr Lenchner); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, NY (Dr Bornstein)
| | - Michelle Greenman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY (Drs Gulersen, Greenman, and Rochelson); Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA (Dr Gyamfi-Bannerman); Biostatistics and Data Management, New York University Rory Meyers College of Nursing, New York, NY (Dr Lenchner); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, NY (Dr Bornstein)
| | - Erez Lenchner
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY (Drs Gulersen, Greenman, and Rochelson); Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA (Dr Gyamfi-Bannerman); Biostatistics and Data Management, New York University Rory Meyers College of Nursing, New York, NY (Dr Lenchner); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, NY (Dr Bornstein)
| | - Burton Rochelson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY (Drs Gulersen, Greenman, and Rochelson); Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA (Dr Gyamfi-Bannerman); Biostatistics and Data Management, New York University Rory Meyers College of Nursing, New York, NY (Dr Lenchner); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, NY (Dr Bornstein)
| | - Eran Bornstein
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY (Drs Gulersen, Greenman, and Rochelson); Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA (Dr Gyamfi-Bannerman); Biostatistics and Data Management, New York University Rory Meyers College of Nursing, New York, NY (Dr Lenchner); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, NY (Dr Bornstein)
| |
Collapse
|
6
|
Physiologic Changes during Sponge Bathing in Premature Infants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052467. [PMID: 33802268 PMCID: PMC7967592 DOI: 10.3390/ijerph18052467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/25/2021] [Accepted: 02/27/2021] [Indexed: 11/17/2022]
Abstract
In this study, we observed physiological reactions of premature infants during sponge bathing in the neonatal intensive care unit (NICU). The infants’ body temperature, heart rate, and oxygen saturation were monitored to examine hypothermia risks during bathing. The participants of the study were 32 premature infants who were hospitalized right after their birth in the V hospital in Korea between December 2012 and August 2013. The informed consents of the study were received from the infants’ parents. The infants were randomly assigned into two-day and four-day bath cycle groups and their physiological reactions were monitored before bathing as well as 5 and 10 min after bathing. The collected data were analyzed using the SPSS statistical package through t-test. A significant drop in body temperature was noted in both groups; that is, 4-day bathing cycle and 2-day bathing cycle (p < 0.001). However, there were no significant changes in heart rate or transcutaneous oxygen levels. There was no significant change between groups at each measurement point. In order to minimize the physiological instability that may be caused during bathing, the care providers should try to complete bathing within the shortest possible time and to make bathing a pleasant and useful stimulus for infants.
Collapse
|
7
|
Cho JA, Son KH, Eom HY, Lim SH, Jun YH, Ahn YM. [Glucose Variations in the First Day of Life of Newborns under Observational Surveillance]. CHILD HEALTH NURSING RESEARCH 2020; 26:212-221. [PMID: 35004466 PMCID: PMC8650938 DOI: 10.4094/chnr.2020.26.2.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/26/2020] [Accepted: 04/03/2020] [Indexed: 11/12/2022] Open
|
8
|
Kreko E, Kola E, Sadikaj F, Dardha B, Tushe E. Neonatal Morbidity in Late Preterm Infants Associated with Intrauterine Growth Restriction. Open Access Maced J Med Sci 2019; 7:3592-3595. [PMID: 32010382 PMCID: PMC6986514 DOI: 10.3889/oamjms.2019.832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 11/05/2022] Open
Abstract
AIM This study aims to compare the neonatal morbidity of Intrauterine growth restricted (IUGR) Late Preterm (LP) babies, to those born Late Preterm but evaluated as Appropriate for Gestational Age (AGA). METHODS The study is a 2-year prospective one that used data from the Neonatal Intensive Care Unit (NICU) charts of LP neonates born in our tertiary maternity hospital "Koço Gliozheni" in Tirana. Congenital anomalies and genetical syndromes are excluded. Neonatal morbidity of IUGR Late Preterm is compared to those born Late Preterm but evaluated as AGA. OR and CI, 95% is calculated. RESULTS Out of 336 LP babies treated in NICU, 88 resulted with IUGR and 206 AGA used as a control group. We found significantly higher morbidity in the IUGR group for hypoglycemia, polycythemia, feeding intolerance, birth asphyxia and seizures, secondary sepsis have higher morbidity but the difference is not significant. No differences were found for hyperbilirubinemia in both groups. No neonatal deaths were observed in both groups. CONCLUSION Our study showed that late preterm IUGR has a significantly higher risk for neonatal morbidity when compared to late preterm AGA babies.
Collapse
Affiliation(s)
- Evelina Kreko
- Service of Neonatology, University Hospital of Obstetrics and Gynecology "Koço Gliozheni", Tirana, Albania
| | - Ermira Kola
- Department of Pediatrics, University Hospital Center "Nene Tereza", Tirana, Albania
| | - Festime Sadikaj
- Department of Pediatrics, University Hospital Center "Nene Tereza", Tirana, Albania
| | - Blerta Dardha
- Department of Pediatrics, University Hospital Center "Nene Tereza", Tirana, Albania
| | - Eduard Tushe
- Service of Neonatology, University Hospital of Obstetrics and Gynecology "Koço Gliozheni", Tirana, Albania
| |
Collapse
|
9
|
Sharma D, Padmavathi IV, Tabatabaii SA, Farahbakhsh N. Late preterm: a new high risk group in neonatology. J Matern Fetal Neonatal Med 2019; 34:2717-2730. [PMID: 31575303 DOI: 10.1080/14767058.2019.1670796] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Late preterm infants are those infants born between 34 0/7 weeks through 36 6/7 week of gestation. These are physiologically less mature and have limited compensatory responses to the extrauterine environment compared with term infants. Despite their increased risk for morbidity and mortality, late preterm newborns are often cared in the well-baby nurseries of hospital after birth and are discharged from the hospital by 2-3 days of postnatal age. They are usually treated like developmentally mature term infants because many of them are of same birth weight and same size as term infants. There is a steady increase in the late preterm birth rate in last decade because of either maternal, fetal, or placental/uterine causes. There has been shift in the distribution of births from term and post-term toward earlier gestations. Although late preterm infants are the largest subgroup of preterm infants, there has been little research on this group until recently. This is mainly because of labeling them as "near-term". Such infants were being looked upon as "almost mature", and were thought as neonate requiring either no or minimal concern. In the obstetric and pediatric practice, late preterm infants are often considered functionally and developmentally mature and often managed by protocols developed for full-term infants. Thus, limited efforts are taken to prolong pregnancy in cases of preterm labor beyond 34 weeks, moreover after 34 weeks most centers do not administer antenatal prophylactic steroids. These practices are based on previous studies reporting neonatal mortality and morbidity in the late preterm period to be only slightly higher in comparison with term infants and whereas in the current scenario the difference is significant. Late preterm infants have 2-3-fold increased risk of morbidities such as hypothermia, hypoglycemia, delayed lung fluid clearance, respiratory distress, poor feeding, jaundice, sepsis, and readmission rates after initial hospital discharge. This leads to huge impact on the overall health care resources. In this review, we cover various aspects of these late preterm infants like etiology, immediate and long-term outcome.
Collapse
Affiliation(s)
- Deepak Sharma
- Department of Neonatology, National Institute of Medical Sciences, Jaipur, India
| | | | | | - Nazanin Farahbakhsh
- Department of Pulmonology, Pediatric Department, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Stomnaroska O, Petkovska E, Jancevska S, Danilovski D. Neonatal Hypoglycemia: Risk Factors and Outcomes. ACTA ACUST UNITED AC 2019; 38:97-101. [PMID: 28593892 DOI: 10.1515/prilozi-2017-0013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Severe neonatal hypoglycemia (HG) leads to neurologic damage, mental retardation, epilepsy, personality disorders, impaired cardiac performance and muscle weakness. We aimed to assess the clinical characteristics of children with hypoglycemia in a random population of newborns. PATIENTS, METHODS AND RESULTS We investigated 84 patients (M:F=35:48) born at the University Clinic for Gynecology and Obstetrics in Skopje (hospitalized in the NICU) who were found to have hypoglycemia. In total 89.25% of the babies were premature. The mean birth weight was 1795.95 +/596.08 grams, the mean birth length was 41.92+/- 4.62 cm, while the mean gestational age was 33.05±3.19 weeks. 32 children (38.08%) were very low birth weight (<1500g), 38 (45.22%) were low birth weight (1500-2500g), while there were 8 children (9.52%) appropriate for age BW and no high BW for age patients (>4000 g). HG duration was 2.42+/-2.41 hours. In the group as a whole, hypoxic-ischemic encephalopathy (HIE) was found in 3 children (3.57%), infections in 22 (26.18%), respiratory distress syndrome (RDS) in 9 patients (10.62%), intracranial haemorrhage in 2 patients (2.38%). There were no inborn errors of metabolism. There were two deaths (2.38%). CONCLUSION Neonatal HG is a significant factor in the overall neonatal mortality. HG can also cause severe invalidity. We found that infections, LBW and low gestational age were most commonly associated with neonatal HG. However the Spearman test showed weak direct correlation, without statistical significance. Neonatal HG requires complex and team interaction of prenatal and postnatal approaches to reduce the incidence of seizures, their consequences and the overall mortality. Special consideration is to be taken in measures that avoid neonatal infections, HIE, LBW and low gestational age. Further studies on a larger population are needed to fully understand and prevent the phenomenon of HG in newborns.
Collapse
Affiliation(s)
- Orhideja Stomnaroska
- University Clinic for Gynecology and Obstetrics, Medical Faculty Skopje, Vodnjanska BB, 1000 Skopje
| | | | - Snezana Jancevska
- University Clinic for Gynecology and Obstetrics, Medical Faculty Skopje
| | | |
Collapse
|
11
|
The Relationship between blood pressure parameters and left ventricular output in neonates. J Perinatol 2019; 39:619-625. [PMID: 30770881 DOI: 10.1038/s41372-019-0337-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/29/2018] [Accepted: 01/25/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the relationship between systolic (SBP), diastolic (DBP), mean (MBP) blood pressures and pulse pressure (PP), and left ventricular output (LVO), a surrogate of systemic blood flow. STUDY DESIGN This retrospective study included neonates who underwent targeted neonatal echocardiography (TNE) in 3-tertiary NICUs over 2 years. Associations between LVO and BP components were investigated. Analysis was adjusted for relevant covariates. RESULT 1060 studies from 485 neonates were included, with a mean GA of 28.4 ± 4.6 weeks and birth weight of 1234 ± 840 grams. LVO was associated positively with SBP and PP, and negatively with GA. PP demonstrated the highest predictive value for identifying infants with LVO < 150 ml/kg/min (area under the curve 0.75 [95% CI 0.68, 0.82]). MBP and DBP demonstrated no correlation with LVO. CONCLUSION BP parameters correlate poorly with LVO, irrespective of GA and underlying etiology. Narrow PP may be more reflective of low LVO than low SBP.
Collapse
|
12
|
Qiao LX, Wang J, Yan JH, Xu SX, Wang H, Zhu WY, Zhang HY, Li J, Feng X. Follow-up study of neurodevelopment in 2-year-old infants who had suffered from neonatal hypoglycemia. BMC Pediatr 2019; 19:133. [PMID: 31023291 PMCID: PMC6485053 DOI: 10.1186/s12887-019-1509-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 04/11/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Neonatal hypoglycemia is tightly related to adverse neurodevelopmental and brain injury outcomes. METHODS A total of 195 infants who were born from diabetic mothers with a low blood glucose level (< 2.6 mM) within 0.5 h after birth were enrolled in this prospective cohort study. Of these, 157 infants who had neonatal hypoglycemia (group A) were followed up, and this group was further divided into A1 [blood glucose concentration (BGC) < 2.6 mM at < 2 h after birth], A2 (BGC < 2.6 mM at 2-24 h after birth), and A3 (BGC < 2.6 mM at > 24 h after birth). A total of 144 infants whose mothers had no high risk for gestational diabetes mellitus were followed up as the control group during the same period. The neurodevelopment of the infants was evaluated by the Gesell scoring method. RESULTS The adaptability in the A2 and A3 subgroups was significantly lower than that in the control group (73.9 ± 6.6 vs. 87.9 ± 11.2; 71.5 ± 8.9 vs. 87.9 ± 11.2, respectively). There were significantly more mothers who used insulin during the perinatal period in A3 than in A1 and A2 (31% vs. 2%; 31% vs. 7.9%, respectively). The mothers of babies in subgroups A2 and A3 gained more weight than those of the control group (15.3 ± 1.9 kg vs. 11.1 ± 2.2 kg; 14.8 ± 2.6 kg vs. 11.1 ± 2.2 kg, respectively). CONCLUSIONS Long and repeated neonatal hypoglycemia caused poor adaptability. The babies of mothers who used insulin or had a high weight gain during pregnancy were associated with severe or persistent neonatal hypoglycemia.
Collapse
Affiliation(s)
- Lin-Xia Qiao
- Department of Neonatology, Children's Hospital of Soochow University, No. 92 Zhongnan Street, Suzhou, 215025, Jiangsu, China.,Department of Pediatrics, The First People's Hospital, Jiangsu University, Kunshan, 215300, Jiangsu, China
| | - Jian Wang
- Department of Children's Healthcare, Kunshan Maternal and Child Health Hospital, Kunshan, 215300, Jiangsu, China
| | - Ju-Hua Yan
- Department of Children's Healthcare, Kunshan Maternal and Child Health Hospital, Kunshan, 215300, Jiangsu, China
| | - Su-Xiang Xu
- Department of Children's Healthcare, Kunshan Maternal and Child Health Hospital, Kunshan, 215300, Jiangsu, China
| | - Hua Wang
- Department of Pediatrics, The First People's Hospital, Jiangsu University, Kunshan, 215300, Jiangsu, China
| | - Wen-Ying Zhu
- Department of Pediatrics, The First People's Hospital, Jiangsu University, Kunshan, 215300, Jiangsu, China
| | - Hai-Yan Zhang
- Department of Pediatrics, The First People's Hospital, Jiangsu University, Kunshan, 215300, Jiangsu, China
| | - Jie Li
- Department of Pediatrics, The First People's Hospital, Jiangsu University, Kunshan, 215300, Jiangsu, China
| | - Xing Feng
- Department of Neonatology, Children's Hospital of Soochow University, No. 92 Zhongnan Street, Suzhou, 215025, Jiangsu, China.
| |
Collapse
|
13
|
Chamberlain J, McCarty S, Sorce J, Leesman B, Schmidt S, Meyrick E, Parlier S, Kennedy L, Crowley D, Coultas L. Impact on delayed newborn bathing on exclusive breastfeeding rates, glucose and temperature stability, and weight loss. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.jnn.2018.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
14
|
Muganthan T, Boyle EM. Early childhood health and morbidity, including respiratory function in late preterm and early term births. Semin Fetal Neonatal Med 2019; 24:48-53. [PMID: 30348617 DOI: 10.1016/j.siny.2018.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Late preterm (LP) and early term (ET) infants have generally been considered in the same way as their healthy full term (FT) counterparts. It is only in the last decade that an increased risk of later poor health in children born LP has been recognised; evidence for health outcomes following ET birth is still emerging. However, reports are largely consistent in highlighting an increased risk, which lessens approaching FT but is measurable and persists into adolescence and beyond. The most thoroughly explored area to date is respiratory morbidity. This article reviews the body of available evidence for effects of LP birth on pulmonary function and ongoing morbidity, and other areas where an increased risk of health problems has been identified in this population. Implications for delivery of health care are considered and areas for further research are highlighted.
Collapse
Affiliation(s)
- Trishula Muganthan
- Neonatal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Elaine M Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK.
| |
Collapse
|
15
|
Gehrand AL, Hoeynck B, Jablonski M, Leonovicz C, Cullinan WE, Raff H. Programming of the Adult HPA Axis After Neonatal Separation and Environmental Stress in Male and Female Rats. Endocrinology 2018; 159:2777-2789. [PMID: 29878093 DOI: 10.1210/en.2018-00370] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/29/2018] [Indexed: 11/19/2022]
Abstract
Maternal separation, hypoxia, and hypothermia are common stressors in the premature neonate. Using our rat model of human prematurity, we evaluated sexual dimorphisms in the long-term effects of these neonatal stressors on behavior of the hypothalamic-pituitary-adrenal (HPA) axis in adult rats. Neonatal rats were exposed daily on postnatal days 2 to 6 to maternal separation with normoxia, with hypoxia allowing spontaneous hypothermia, with hypothermia per se, and with hypoxia while maintaining isothermia with external heat. The major findings were that (a) prior maternal-neonatal separation during the first week of postnatal life attenuated the plasma ACTH and corticosterone response to restraint stress in adult male but not female rats, (b) prior neonatal hypothermia augmented the plasma ACTH and corticosterone response to restraint stress in adult male rats, but not female rats, and (c) changes in hypothalamic, pituitary, and adrenal mRNA expression did not account for most of these HPA axis effects. Most of the programming effects on adult HPA axis was attributed to prior maternal-neonatal separation alone (with normoxia) because the addition of hypoxia with spontaneous hypothermia, hypothermia per se, and hypoxia while preventing hypothermia during maternal-neonatal separation had minimal effects on the HPA axis. These results may inform strategies to prevent sexually dimorphic sequelae of neonatal stress including those due to medical interventions.
Collapse
Affiliation(s)
- Ashley L Gehrand
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute, Milwaukee, Wisconsin
| | - Brian Hoeynck
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute, Milwaukee, Wisconsin
| | - Mack Jablonski
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute, Milwaukee, Wisconsin
| | - Cole Leonovicz
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute, Milwaukee, Wisconsin
| | - William E Cullinan
- Department of Biomedical Sciences, Marquette University, Milwaukee, Wisconsin
| | - Hershel Raff
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute, Milwaukee, Wisconsin
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
16
|
Impact of NICU admission on Colorado-born late preterm infants: breastfeeding initiation, continuation and in-hospital breastfeeding practices. J Perinatol 2018; 38:557-566. [PMID: 29371628 DOI: 10.1038/s41372-018-0042-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 12/07/2017] [Accepted: 01/02/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Compare breastfeeding initiation and continuation rates, and in-hospital breastfeeding practices, of late preterm infants (LPIs) cared for in a NICU versus those cared for exclusively in the nursery (non-NICU). STUDY DESIGN Using data from the 2009-2014 Colorado Pregnancy Risk Assessment Monitoring System (PRAMS), breastfeeding initiation, continuation, and in-hospital breastfeeding practices of NICU versus non-NICU LPIs (34 0/7 to 36 6/7 weeks gestation, n = 20,767) were analyzed, and multivariate models were created controlling for maternal and infant characteristics. RESULTS Mothers of NICU LPIs were equally likely to initiate breastfeeding (APR 1.0; 95% CI 0.95-1.06) but less likely to continue breastfeeding at 10 weeks (APR 0.86; 95% CI 0.76-0.99) compared to mothers of non-NICU LPIs. Mothers of NICU LPIs were less likely to breastfeed in the hospital, less likely to be told to feed infants on demand, and more likely to be given a breast pump during hospitalization. CONCLUSIONS There are significant differences in both breastfeeding continuation and several in-hospital breastfeeding practices for NICU versus non-NICU LPIs. Further research is needed so that targeted policies and programs can be developed to improve breastfeeding rates in this vulnerable population.
Collapse
|
17
|
Besser L, Sabag-Shaviv L, Yitshak-Sade M, Mastrolia SA, Landau D, Beer-Weisel R, Klaitman V, Benshalom-Tirosh N, Mazor M, Erez O. Medically indicated late preterm delivery and its impact on perinatal morbidity and mortality: a retrospective population-based cohort study. J Matern Fetal Neonatal Med 2018; 32:3278-3287. [PMID: 29621920 DOI: 10.1080/14767058.2018.1462325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: In the last few decades, attention has been focused on morbidity and mortality associated with late preterm delivery (34-36 + 6/7 weeks), accounting for 60-70% of all preterm births. This study is aimed to determine (1) the prevalence of late preterm deliveries (spontaneous and medically indicated) in our population; and (2) the rate of neonatal morbidity and mortality as well as maternal complications associated with the different phenotypes of late preterm deliveries. Study design: This retrospective population-based cohort study, included 96,176 women who had 257,182 deliveries, occurred between 1988 and 2011, allocated into three groups: term (n = 242,286), spontaneous (n = 10,063), and medically indicated (n = 4833) late preterm deliveries. Results: (1) Medically indicated late preterm deliveries were associated with increased maternal morbidity, as well as neonatal morbidity and mortality, in comparison with other study groups (p < .01 for all comparisons); (2) medically indicated late preterm delivery was an independent risk factor for composite neonatal morbidity (low Apgar score at 5', seizures, asphyxia, acidosis) after adjustment for confounding factors (maternal age and ethnicity and neonatal gender) and stratification according to gestational age at delivery; and (3) the proportion of medically indicated late preterm deliveries affected the neonatal mortality rate. Below 35% of all late preterm deliveries, indicated late preterm birth were associated with a reduction in neonatal mortality; however, above this threshold medically indicated late preterm deliveries were associated with an increased risk for neonatal death. Conclusions: (1) Medically indicated late preterm deliveries were independently associated with adverse composite neonatal outcome; and (2) to benefit in term of neonatal outcome from the tool of medically indicated late preterm birth, their proportion should be kept below 35% of all late preterm deliveries, while exceeding this threshold increases the risk of neonatal mortality.
Collapse
Affiliation(s)
- Limor Besser
- a Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences , Ben Gurion University of the Negev , Be'er Sheva , Israel
| | - Liat Sabag-Shaviv
- b School of Medicine, Faculty of Health Sciences , Ben Gurion University of the Negev , Be'er Sheva , Israel
| | - Maayan Yitshak-Sade
- c Clinical Research Center , Soroka University Medical Center, Ben Gurion University of the Negev , Be'er Sheva , Israel
| | - Salvatore Andrea Mastrolia
- a Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences , Ben Gurion University of the Negev , Be'er Sheva , Israel.,d Department of Maternal Fetal Medicine , Fondazione MBBM, San Gerardo Hospital, Università degli Studi di Milano-Bicocca , Monza , Italy
| | - Danielle Landau
- e Department of Neonatology, Faculty of Health Sciences , Soroka University Medical Center, Ben Gurion University of the Negev , Be'er Sheva , Israel
| | - Ruthy Beer-Weisel
- a Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences , Ben Gurion University of the Negev , Be'er Sheva , Israel
| | - Vered Klaitman
- a Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences , Ben Gurion University of the Negev , Be'er Sheva , Israel
| | - Neta Benshalom-Tirosh
- a Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences , Ben Gurion University of the Negev , Be'er Sheva , Israel
| | - Moshe Mazor
- a Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences , Ben Gurion University of the Negev , Be'er Sheva , Israel
| | - Offer Erez
- f Maternity Department D and Obstetrical Day care Unit , Soroka University Medical Center, Ben Gurion University of the Negev , Be'er Sheva , Israel
| |
Collapse
|
18
|
Currie G, Dosani A, Premji SS, Reilly SM, Lodha AK, Young M. Caring for late preterm infants: public health nurses' experiences. BMC Nurs 2018; 17:16. [PMID: 29713242 PMCID: PMC5907172 DOI: 10.1186/s12912-018-0286-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 04/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Public health nurses (PHNs) care for and support late preterm infants (LPIs) and their families when they go home from the hospital. PHNs require evidence-informed guidelines to ensure appropriate and consistent care. The objective of this research study is to capture the lived experience of PHNs caring for LPIs in the community as a first step to improving the quality of care for LPIs and support for their parents. METHODS To meet our objectives we chose a descriptive phenomenology approach as a method of inquiry. We conducted semi-structured interviews with PHNs (n = 10) to understand PHN perceptions of caring for LPIs and challenges in meeting the needs of families within the community. Interpretative thematic analysis revealed PHN perceptions of caring for LPIs and challenges in meeting the needs of families within the community. RESULTS Four themes emerged from the data. First, PHNs expressed challenges with meeting the physiological needs of LPIs and gave voice to the resulting strain this causes for parents. Second, nurses conveyed that parents require more anticipatory guidance about the special demands associated with feeding LPIs. Third, PHNs relayed that parents sometimes receive inconsistent advice from different providers. Lastly, PHNs acknowledged that due to lack of resources, families sometimes did not receive the full scope of evidence informed care required by fragile, immature infants. CONCLUSION The care of LPIs by PHNs would benefit from more research about the needs of these infants and their families. Efforts to improve quality of care should focus on: evidence-informed guidelines, consistent care pathways, coordination of follow up care and financial resources, to provide physical, emotional, informational support that families require once they leave the hospital. More research on meeting the challenges of caring for LPIs and their families would provide direction for the competencies PHNs require to improve the quality of care in the community.
Collapse
Affiliation(s)
- Genevieve Currie
- School of Nursing and Midwifery, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, Alberta T3E 6K6 Canada
| | - Aliyah Dosani
- School of Nursing and Midwifery, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, Alberta T3E 6K6 Canada
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta Canada
| | - Shahirose S. Premji
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta Canada
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4 Canada
| | - Sandra M. Reilly
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta Canada
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4 Canada
| | - Abhay K. Lodha
- Department of Paediatrics, Section of Neonatology, Alberta Health Services, Foothills Medical Centre, 1403 29th Street NW, Calgary, Alberta T2N 2T9 Canada
- Alberta Children’s Hospital Research Institute, Calgary, Alberta Canada
| | - Marilyn Young
- Prenatal & Postpartum Services, Public Health Calgary Zone, Alberta Health Services, 1430, 10101 Southport Road SW, Calgary, Alberta T2W 3N2 Canada
| |
Collapse
|
19
|
Dassios T, Greenough A, Leontiadi S, Hickey A, Kametas NA. Admissions for hypoglycaemia after 35 weeks of gestation: perinatal predictors of cost of stay. J Matern Fetal Neonatal Med 2018; 32:448-454. [PMID: 28922987 DOI: 10.1080/14767058.2017.1381905] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hypoglycaemia accounts for approximately one-tenth of term admissions to neonatal units can cause long-term neurodevelopmental impairment and is associated with the significant burden to the affected infants, families and the health system. OBJECTIVE To define the prevalence, length and cost of admissions for hypoglycaemia in infants born at greater than 35 weeks gestation and to identify antenatal and perinatal predictors of those outcomes. MATERIALS AND METHODS This was a retrospective audit of infants admitted for hypoglycaemia between 1 January 2012 and 31 December 2015, in a level three neonatal intensive care unit at King's College Hospital NHS Foundation Trust, London. The main outcome measures were the prevalence, length and cost of admissions for hypoglycaemia and antenatal and postnatal predictors of the length and cost of the stay. RESULTS There were 474 admissions for hypoglycaemia (17.8% of total admissions). Their median (IQR) blood glucose on admission was 2.1 (1.7-2.4) mmol/l, gestation at delivery 38.1 (36.7-39.3) weeks, birthweight percentile 31.4 (5.4-68.9), their length of stay was 3.0 (2.0-5.0). Admissions equated to a total of 2107 hospital days. The total cost of the stay was 1,316,591 Great Britain pound. The antenatal factors associated with admission for hypoglycaemia were maternal hypertension (19.8%), maternal diabetes (24.5%), foetal growth restriction (FGR) (25.9%) and pathological intrapartum cardiotocograph (23.4%). In 13.7% of cases, there was no associated pregnancy complication. Multivariate logistic regression analysis demonstrated lower gestational age, z-score birthweight squared, exclusive breastfeeding and maternal prescribed nifedipine were independently associated with the length and cost of the stay. CONCLUSION Hypoglycaemia accounted for approximately one-fifth of admissions after 35-week gestation. Lower gestational age and admission blood glucose, low and high z-score birthweight, maternal nifedipine and exclusive breastfeeding are associated with longer duration of stay.
Collapse
Affiliation(s)
- Theodore Dassios
- a Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust , Denmark Hill, London , UK
| | - Anne Greenough
- b Division of Asthma , Allergy and Lung Biology, MRC-Asthma UK National , London , UK.,c Institute for Health Research (NIHR) Biomedical Research Centre , King's College London , UK.,d King's College Hospital NHS Foundation Trust, Denmark Hill , London , UK
| | - Stamatina Leontiadi
- a Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust , Denmark Hill, London , UK
| | - Ann Hickey
- a Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust , Denmark Hill, London , UK
| | - Nikos A Kametas
- e Antenatal Hypertension Clinic, Fetal Medicine Research Institute, King's College Hospital , London , UK
| |
Collapse
|
20
|
Stewart B, Karahalios A, Pszczola R, Said J. Moderate to late preterm intrauterine growth restriction: A restrospective, observational study of the indications for delivery and outcomes in an Australian perinatal centre. Aust N Z J Obstet Gynaecol 2017; 58:306-314. [DOI: 10.1111/ajo.12721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 08/29/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Bridie Stewart
- Sunshine Hospital, Western Health; Melbourne Victoria Australia
- University of Melbourne; Melbourne Victoria Australia
| | - Amalia Karahalios
- Sunshine Hospital, Western Health; Melbourne Victoria Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health; University of Melbourne; Melbourne Victoria Australia
| | | | - Joanne Said
- Sunshine Hospital, Western Health; Melbourne Victoria Australia
- University of Melbourne; Melbourne Victoria Australia
| |
Collapse
|
21
|
Raff H, Hoeynck B, Jablonski M, Leonovicz C, Phillips JM, Gehrand AL. Insulin sensitivity, leptin, adiponectin, resistin, and testosterone in adult male and female rats after maternal-neonatal separation and environmental stress. Am J Physiol Regul Integr Comp Physiol 2017; 314:R12-R21. [PMID: 28877872 DOI: 10.1152/ajpregu.00271.2017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Care of premature infants often requires parental and caregiver separation, particularly during hypoxic and hypothermic episodes. We have established a neonatal rat model of human prematurity involving maternal-neonatal separation and hypoxia with spontaneous hypothermia prevented by external heat. Adults previously exposed to these neonatal stressors show a sex difference in the insulin and glucose response to arginine stimulation suggesting a state of insulin resistance. The current study used this cohort of adult rats to evaluate insulin resistance [homeostatic model assessment of insulin resistance (HOMA-IR)], plasma adipokines (reflecting insulin resistance states), and testosterone. The major findings were that daily maternal-neonatal separation led to an increase in body weight and HOMA-IR in adult male and female rats and increased plasma leptin in adult male rats only; neither prior neonatal hypoxia (without or with body temperature control) nor neonatal hypothermia altered subsequent adult HOMA-IR or plasma adiponectin. Adult male-female differences in plasma leptin were lost with prior exposure to neonatal hypoxia or hypothermia; male-female differences in resistin were lost in the adults that were exposed to hypoxia and spontaneous hypothermia as neonates. Exposure of neonates to daily hypoxia without spontaneous hypothermia led to a decrease in plasma testosterone in adult male rats. We conclude that neonatal stressors result in subsequent adult sex-dependent increases in insulin resistance and adipokines and that our rat model of prematurity with hypoxia without hypothermia alters adult testosterone dynamics.
Collapse
Affiliation(s)
- Hershel Raff
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute , Milwaukee, Wisconsin.,Departments of Medicine, Surgery, and Physiology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Brian Hoeynck
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute , Milwaukee, Wisconsin
| | - Mack Jablonski
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute , Milwaukee, Wisconsin
| | - Cole Leonovicz
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute , Milwaukee, Wisconsin
| | - Jonathan M Phillips
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute , Milwaukee, Wisconsin
| | - Ashley L Gehrand
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute , Milwaukee, Wisconsin
| |
Collapse
|
22
|
Stomnaroska O, Petkovska E, Ivanovska S, Jancevska S, Danilovski D. Hypoglycaemia in the Newborn. ACTA ACUST UNITED AC 2017; 38:79-84. [PMID: 28991764 DOI: 10.1515/prilozi-2017-0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM Severe neonatal hypoglycaemia (HG) leads to neurologic damage, mental retardation, epilepsy, impaired cardiac performance and muscle weakness. The aim was to assess the frequency and severity of HG in a population of newborns. PATIENTS AND METHODS We investigated 739 patients with neonatal hypoglycaemia (HG) (M:F=370:369) born at the University Clinic for Gynaecology and Obstetritics in Skopje in the period 2014-2016 and treated at the neonatal intensive care unit (NICU). 1416 babies were treated in the same period in NICU, and HG was observed in 52.18%. The birth weight was dominated by children with low birth weight: very low birth weight (VLBW)(<1500g) 253 children, (34,23%), low birth weight (1500-2500g) 402 (54.39%), appropriate for gestational age (AGA) 78(10.55%), and high birth weight (>4000g) 6 babies (0.81%). The gestational age was also dominated by children with low gestational age: gestational week (GW) 20-25 four children (0.54%), 26-30 GW 133 babies (17.99%), 31-35 GW472 (63.87%), and 36-40 GW130 neonates (17.59 %). 241 mothers (32.61%) have had an infection during pregnancy, 82 preeclampsia or eclampsia (11.09%), 20 diabetes mellitus (2.70%), 78 placental situations (placenta previa, abruption) (10.55%). In this study 47 babies (6.35%) with HG and co-morbidities died. There was a significant positive correlation between HG birth weight (p<0.01), gestational age (p<0.05), and the lowest Apgar score (p<0.01). Neonatal deaths were significantly correlated with GA (р>0,01), co-morbidities of the mothers (р>0,05) but not with the birth weight (р>0,05). In contrast, a significant positive correlation was found between convulsions and body weight (р<0.05). The lowest Apgar score was positively correlated with the gestational age (0.01), but not with the birth weight (0.05). CONCLUSION Low birth weight, low gestational age, maternal risk factors, hypoxic-ischemic encephalopathy and neonatal infections are associated with HG and are a significant factor in overall neonatal mortality. Those results indicate that diminishing the frequency of the neonatal HG and the rates of neonatal mortality requires complex interaction of prenatal and postnatal interventions.
Collapse
|
23
|
Gehrand AL, Hoeynck B, Jablonski M, Leonovicz C, Ye R, Scherer PE, Raff H. Sex differences in adult rat insulin and glucose responses to arginine: programming effects of neonatal separation, hypoxia, and hypothermia. Physiol Rep 2016; 4:e12972. [PMID: 27664190 PMCID: PMC5037920 DOI: 10.14814/phy2.12972] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 08/22/2016] [Indexed: 01/26/2023] Open
Abstract
Acute neonatal hypoxia, a common stressor, causes a spontaneous decrease in body temperature which may be protective. There is consensus that hypothermia should be prevented during acute hypoxia in the human neonate; however, this may be an additional stress with negative consequences. We hypothesize that maintaining body temperature during hypoxia in the first week of postnatal life alters the subsequent insulin, glucose, and glucagon secretion in adult rats. Rat pups were separated from their dam daily from postnatal days (PD) 2-6 for the following 90 min experimental treatments: (1) normoxic separation (control), (2) hypoxia (8% O2) allowing spontaneous hypothermia, (3) normoxic hypothermia with external cold, and (4) exposure to 8% O2 while maintaining body temperature using external heat. An additional normoxic non-separated control group was performed to determine if separation per se changed the adult phenotype. Plasma insulin, glucose, and glucagon responses to arginine stimulation were evaluated from PD105 to PD133. Maternal separation (compared to non-separated neonates) had more pronounced effects on the adult response to arginine compared to the hypoxic, hypothermic, and hypoxic-isothermic neonatal treatments. Adult males exposed to neonatal maternal separation had augmented insulin and glucose responses to arginine compared to unseparated controls. Additionally, neonatal treatment had a significant effect on body weight gain; adults exposed to neonatal maternal separation were significantly heavier. Female adults had significantly smaller insulin and glucose responses to arginine regardless of neonatal treatment. Neonatal maternal separation during the first week of life significantly altered adult beta-cell function in a sexually dimorphic manner.
Collapse
Affiliation(s)
- Ashley L Gehrand
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute, Milwaukee, Wisconsin
| | - Brian Hoeynck
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute, Milwaukee, Wisconsin
| | - Mack Jablonski
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute, Milwaukee, Wisconsin
| | - Cole Leonovicz
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute, Milwaukee, Wisconsin
| | - Risheng Ye
- Touchstone Diabetes Center, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Philipp E Scherer
- Touchstone Diabetes Center, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Hershel Raff
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute, Milwaukee, Wisconsin Departments of Medicine, Surgery, and Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
24
|
Simmonds C. Review of practice: Facilitating normality at caesarean section. J Perioper Pract 2016; 26:166-169. [PMID: 29328756 DOI: 10.1177/1750458916026007-802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/18/2016] [Indexed: 06/07/2023]
Abstract
Expectant women often write detailed birth plans outlining their preferences for the birth of their baby. These plans are pushed aside when a caesarean is deemed necessary, being replaced with medical decisions in a clinical setting. In the busiest maternity unit in the South West, our team are trying to change this attitude, encompassing many of the key points of 'normal' birth choices that are important to mothers during caesarean section, without compromising clinical care.
Collapse
|
25
|
Bulut C, Gürsoy T, Ovalı F. Short-Term Outcomes and Mortality of Late Preterm Infants. Balkan Med J 2016; 33:198-203. [PMID: 27403390 DOI: 10.5152/balkanmedj.2016.16721] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 10/27/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Late preterm infants have increased rates of morbidity and mortality compared to term infants. Determining the risk factors in these infants leads to more comprehensive preventive and treatment strategies. AIMS Our aim was to analyse the morbidity rates such as respiratory system diseases, infections, congenital anomalies, hypoglycemia and hematologic abnormalities and mortality rates in a large group of patients at a referral center. STUDY DESIGN Retrospective cross-sectional study. METHODS Medical records of late preterm and term infants who were managed at the referral center were analysed. RESULTS 41752 births were analysed in 3 years. 71.9% of all births were between 37-42 gestational weeks (i.e. term) and 16.1% were between 34-37 weeks (i.e. late preterm). Compared to term infants, late preterm infants had increased rates of short-term problems. The rate of mortality increased with decreased gestational age. The duration of hospitalization was significantly higher in the smallest late preterm infants. CONCLUSION This study demonstrated the need that late preterm infants who have higher risk for morbidity and mortality, compared to term infants require close monitoring. The rate of mortality and hospitalization increased with decreased gestational age.
Collapse
Affiliation(s)
- Cahide Bulut
- Neonatal Intensive Care Unit, Zeynep Kamil Maternity and Children's Diseases Training and Research Hospital, İstanbul, Turkey
| | - Tuğba Gürsoy
- Neonatal Intensive Care Unit, Zeynep Kamil Maternity and Children's Diseases Training and Research Hospital, İstanbul, Turkey
| | - Fahri Ovalı
- Neonatal Intensive Care Unit, Zeynep Kamil Maternity and Children's Diseases Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
26
|
Field D, Boyle E, Draper E, Evans A, Johnson S, Khan K, Manktelow B, Marlow N, Petrou S, Pritchard C, Seaton S, Smith L. Towards reducing variations in infant mortality and morbidity: a population-based approach. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundOur aims were (1) to improve understanding of regional variation in early-life mortality rates and the UK’s poor performance in international comparisons; and (2) to identify the extent to which late and moderately preterm (LMPT) birth contributes to early childhood mortality and morbidity.ObjectiveTo undertake a programme of linked population-based research studies to work towards reducing variations in infant mortality and morbidity rates.DesignTwo interlinked streams: (1) a detailed analysis of national and regional data sets and (2) establishment of cohorts of LMPT babies and term-born control babies.SettingCohorts were drawn from the geographically defined areas of Leicestershire and Nottinghamshire, and analyses were carried out at the University of Leicester.Data sourcesFor stream 1, national data were obtained from four sources: the Office for National Statistics, NHS Numbers for Babies, Centre for Maternal and Child Enquiries and East Midlands and South Yorkshire Congenital Anomalies Register. For stream 2, prospective data were collected for 1130 LMPT babies and 1255 term-born control babies.Main outcome measuresDetailed analysis of stillbirth and early childhood mortality rates with a particular focus on factors leading to biased or unfair comparison; review of clinical, health economic and developmental outcomes over the first 2 years of life for LMPT and term-born babies.ResultsThe deprivation gap in neonatal mortality has widened over time, despite government efforts to reduce it. Stillbirth rates are twice as high in the most deprived as in the least deprived decile. Approximately 70% of all infant deaths are the result of either preterm birth or a major congenital abnormality, and these are heavily influenced by mothers’ exposure to deprivation. Births at < 24 weeks’ gestation constitute only 1% of all births, but account for 20% of infant mortality. Classification of birth status for these babies varies widely across England. Risk of LMPT birth is greatest in the most deprived groups within society. Compared with term-born peers, LMPT babies are at an increased risk of neonatal morbidity, neonatal unit admission and poorer long-term health and developmental outcomes. Cognitive and socioemotional development problems confer the greatest long-term burden, with the risk being amplified by socioeconomic factors. During the first 24 months of life each child born LMPT generates approximately £3500 of additional health and societal costs.ConclusionsHealth professionals should be cautious in reviewing unadjusted early-life mortality rates, particularly when these relate to individual trusts. When more sophisticated analysis is not possible, babies of < 24 weeks’ gestation should be excluded. Neonatal services should review the care they offer to babies born LMPT to ensure that it is appropriate to their needs. The risk of adverse outcome is low in LMPT children. However, the risk appears higher for some types of antenatal problems and when the mother is from a deprived background.Future workFuture work could include studies to improve our understanding of how deprivation increases the risk of mortality and morbidity in early life and investigation of longer-term outcomes and interventions in at-risk LMPT infants to improve future attainment.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
Collapse
Affiliation(s)
- David Field
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Elaine Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Elizabeth Draper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alun Evans
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Kamran Khan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Bradley Manktelow
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Neil Marlow
- Institute for Women’s Health, University College London, London, UK
| | - Stavros Petrou
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Sarah Seaton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Lucy Smith
- Department of Health Sciences, University of Leicester, Leicester, UK
| |
Collapse
|
27
|
Camann W. The gentle family-centered cesarean. HYPERTENSION RESEARCH IN PREGNANCY 2016. [DOI: 10.14390/jsshp.hrp2016-004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- William Camann
- Associate Professor of Anesthesia, Harvard Medical School, Director of Obstetric Anesthesia, Brigham & Women’s Hospital
| |
Collapse
|
28
|
Abstract
PURPOSE OF REVIEW To provide an overview of the literature regarding medical and developmental risks for moderate to late preterm infants (32-36 weeks gestation), with particular attention to the pediatrician's role in care during both inpatient and outpatient periods. RECENT FINDINGS Although the risks of medical issues and developmental delays decrease with increasing gestational age, research suggests that infants born after 32 weeks' gestation often exhibit significant morbidities associated with prematurity. These infants, often referred to as 'macro preemies', have been found to be at a greater risk for medical complications secondary to immature organ systems including impairments in temperature regulation, respiratory functioning, feeding coordination, bilirubin excretion, glucose control, and infection susceptibility. Recent studies of macro preemies also suggest a higher incidence of significant deficits noted in gross and fine motor skills, speech and communication, and learning and behavior compared to their full-term counterparts. Without careful attention from birth, macro preemie infants could be susceptible to both medical issues and developmental delays. SUMMARY Physicians should be aware of the research regarding increased medical and developmental risks for all infants born before term in order to provide their patients with comprehensive medical and neurodevelopmental follow-up care.
Collapse
|
29
|
Akinloye O, O'Connell C, Allen AC, El-Naggar W. Post-resuscitation care for neonates receiving positive pressure ventilation at birth. Pediatrics 2014; 134:e1057-62. [PMID: 25266427 DOI: 10.1542/peds.2014-0554] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To investigate if postresuscitation care (PRC) is indicated for all infants ≥35 weeks' gestation who receive positive pressure ventilation (PPV) at birth, explore the aspects of this care and the factors most predictive of it. METHODS Our hospital admits any infant who requires PPV at birth to special (intermediate/intensive) neonatal care unit (SNCU) for observation for at least 6 hours. All infants ≥35 weeks' gestation born between 1994 and 2013, who received PPV at birth, were reviewed. We examined perinatal factors that could predict the need for PRC after short (<1 minute) and prolonged (≥1 minute) PPV, admission course, neonatal morbidities, and the aspects of care given. RESULTS Among 87 464 infants born, 3658 (4.2%) had PPV at birth with 3305 (90%) admitted for PRC. Of those, 1558 (42.6%) were in the short PPV group and 2100 (57.4%) in the prolonged PPV group. Approximately 59% of infants who received short PPV stayed in the SNCU for ≥1 day. Infants who received prolonged PPV were more likely to have morbidities and require special neonatal care. Multiple logistic regression analysis revealed the risk factors of placental abruption, assisted delivery, small-for-dates, gestational age <37 weeks, low 5-minute Apgar score, and need for intubation at birth to be independent predictors for SNCU stay ≥1 day and need for assisted ventilation, central lines, and parenteral nutrition. CONCLUSIONS Our data support the need for PRC even for infants receiving short PPV at birth.
Collapse
Affiliation(s)
- Olusegun Akinloye
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, and
| | - Colleen O'Connell
- Perinatal Epidemiology Research Unit, Departments of Obstetrics & Gynecology and Pediatrics, Dalhousie University, Halifax, Canada
| | - Alexander C Allen
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, and Perinatal Epidemiology Research Unit, Departments of Obstetrics & Gynecology and Pediatrics, Dalhousie University, Halifax, Canada
| | - Walid El-Naggar
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, and
| |
Collapse
|
30
|
Abstract
In spite of increased appreciation that all preterm infants and early term infants are at higher risk for mortality and morbidities compared with their term counterparts, there are many knowledge gaps affecting optimal clinical care for this vulnerable population. This article presents a research agenda focusing on the systems biology, epidemiology, and clinical and translational sciences on this topic.
Collapse
Affiliation(s)
- Tonse N K Raju
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6100 Executive Boulevard, Room 4B03, Bethesda, MD 20892-MS 7510, USA.
| |
Collapse
|
31
|
Sahni R, Polin RA. Physiologic underpinnings for clinical problems in moderately preterm and late preterm infants. Clin Perinatol 2013; 40:645-63. [PMID: 24182953 DOI: 10.1016/j.clp.2013.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This article highlights some of the important developmental characteristics that underpin common problems seen in moderate and late preterm infants. Preterm birth is associated with an increased prevalence of clinical problems caused by functional immaturities in a wide variety of organ systems, acquired problems, and problems associated with inadequate monitoring and/or follow-up plans. There are variations in the degree of maturation among infants of similar gestational ages because the developmental process is nonlinear. Therefore, different organ systems mature at rates and trajectories that are specific to their functions. A better understanding of these principles can help guide optimal treatment strategies.
Collapse
Affiliation(s)
- Rakesh Sahni
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, 3959 Broadway, MSCHN-1201, New York, NY 10032, USA
| | | |
Collapse
|
32
|
Celik IH, Demirel G, Canpolat FE, Dilmen U. A common problem for neonatal intensive care units: late preterm infants, a prospective study with term controls in a large perinatal center. J Matern Fetal Neonatal Med 2012; 26:459-62. [PMID: 23106478 DOI: 10.3109/14767058.2012.735994] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Compared with term infants, late preterm infants are immature physiologically and metabolically, and have higher risks for medical complications such as respiratory distress, hypoglycemia, hyperbilirubinemia, sepsis, feeding difficulty and poor neurodevelopmental outcomes. The incidence of late preterm birth is increasing. We evaluated the clinical and demographic characteristics, short-term outcomes and clinical courses of late preterm infants admitted to our neonatal intensive care unit (NICU). Data from NICU admissions of 605 late preterm and 1477 term infants in the 1-year period between June 2010 and May 2011 were analyzed. There were 2004 late preterm deliveries and 18,854 total deliveries. Of late preterm infants, 30% were admitted to the NICU. The mean gestational age and birth weight were 35(1/7) weeks and 2352 g, respectively. The admission diagnoses were respiratory distress (46.5%), low birth weight (17.5%), jaundice (13.7%), feeding difficulty (13.1%), polycythemia (8.1%) and hypoglycemia (4%); these morbidity rates were higher than those in term infants (p < 0.001). The overall mean hospitalization period was 7.5 ± 9.1 days. The respective mortality and rehospitalization rates were 2.1% and 4.4%, which were higher than those for term infants (p < 0.001). In conclusion, late preterm infants should be followed closely for the complications just after birth, and preventive strategies should be developed.
Collapse
Affiliation(s)
- Istemi Han Celik
- Division of Neonatology, Neonatal Intensive Care Unit, Mersin Maternal and Child Health Hospital, Mersin, Turkey.
| | | | | | | |
Collapse
|
33
|
Abstract
Late preterm infants are infants who are premature, but often mature enough to be managed in settings and with treatment plans appropriate for term newborns. They are arbitrarily defined as infants born at gestational ages of 34, 35 and 36 weeks. Late preterm infants have more problems with adaptation than term infants, and may require neonatal intensive care and prolonged admission. However, those who do not may, appropriately, be triaged to mother-baby care in a low-risk nursery setting. Special attention must be offered to the late preterm infant in ensuring adequate thermal homeostasis and the establishment of successful feeding before discharge. In particular, care must be taken to ensure that these babies do not experience severe late hyperbilirubinemia, which characteristically occurs in the breastfeeding late preterm infant at four to five days of age and is not always predictable by routine bilirubin screening before 48 h of age. Discharge of a late preterm infant places particular demands on the community; accessible facilities for retesting, re-evaluation and readmission must be made available by the discharging institution.
Collapse
|
34
|
Abstract
It is well recognised that birth before 32 weeks of gestation is associated with substantial neonatal morbidity and mortality and these risks have been extensively reported. The focus of perinatal research for many years has therefore been very preterm and extremely preterm delivery, since the likelihood and severity of adverse neonatal outcomes are highest within this group. In contrast, until recently, more mature preterm infants have been understudied and indeed, almost ignored by researchers.
Collapse
|
35
|
Abstract
Late and moderate preterm infants account for >80% of premature births. These newborns experience considerable mortality and morbidity in comparison with full-term born infants. The purpose of this paper is to summarise the most common morbidities of late and moderate preterm infants in the neonatal period, their incidence, severity, risk factors and need for admission to the different levels of care. The recent findings on preventive strategies and management priorities for clinical care of these vulnerable babies are also reviewed.
Collapse
|
36
|
Prevalence and morbidity of late preterm infants: current status in a medical center of Northern Taiwan. Pediatr Neonatol 2012; 53:171-7. [PMID: 22770105 DOI: 10.1016/j.pedneo.2012.04.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 07/07/2011] [Accepted: 07/14/2011] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND "Late preterm" defines infants born at 34(0/7) through 36(6/7) weeks' gestation, which comprise a majority of preterm births. These infants were treated clinically as "near-term" in the past, but recent studies have implied increased morbidities that differentiate late preterm and term infants. The purpose of this study was to examine the prevalence and clinical complications that could be associated with late preterm birth, as compared to term. METHODS This was a retrospective cohort study that reviewed infants born in a medical center in Northern Taiwan during a 2-year period between 2008 and 2009. Maternal obstetrical factors, neonatal demographic distributions, and neonatal complications were compared between full-term and late preterm deliveries. RESULTS During the study period, there were 7998 live births in the institute, including 6507 term and 1491 preterm infants. Of the latter, there were 914 (61.3%) born after 34 weeks' gestation. The Neonatal Intensive Care Unit (NICU) (including a special care nursery) admission rate was higher in late preterm infants when compared to term (36% vs. 2%), and was 74%, 43%, and 21% in infants born at 34, 35, and 36 weeks' gestation, respectively. Compared with term infants, late-preterm infants had longer hospital stay if admitted to NICU (including special care nursery) (17 days vs. 10 days), and they were associated with increased risk of neonatal morbidities, including respiratory distress syndrome (2.6% vs. 0.02%), respiratory distress of other etiologies (16% vs. 2%), culture-proven sepsis (0.7% vs. 0.2%), hypoglycemia (3% vs. 0.4%), temperature instability (0.4% vs. 0.05%), feeding difficulty (2% vs. 0.4%), and hyperbilirubinemia needing phototherapy (14% vs. 3%). Late-preterm infants also had higher hospital readmission rate (4.4% vs. 2.3%, p<0.001) and neonatal mortality rate (0.3% vs. 0.08%, p=0.03). CONCLUSION Late-preterm infants have increased risk of neonatal morbidities associated with organ immaturity. The results of this study emphasize the importance of judicious obstetrical decision-making when considering late preterm delivery, and the need to set up anticipatory clinical guidelines for the care of late preterm infants.
Collapse
|
37
|
Abstract
This is a brief review of the developmental physiology of selected organ and functional systems in moderate and late preterm infants. This outline provides a discussion of the physiological underpinnings for some of the clinical conditions seen in this group of infants, including hypothermia, hypoglycemia, respiratory distress syndrome, transient tachypnea, severe respiratory failure, apnea, feeding difficulties, jaundice, and increased susceptibility to infections.
Collapse
Affiliation(s)
- Tonse N K Raju
- Center for Developmental Biology and Perinatal Medicine, National Institutes of Health, Bethesda, Maryland, USA.
| |
Collapse
|
38
|
Loring C, Gregory K, Gargan B, LeBlanc V, Lundgren D, Reilly J, Stobo K, Walker C, Zaya C. Tub Bathing Improves Thermoregulation of the Late Preterm Infant. J Obstet Gynecol Neonatal Nurs 2012; 41:171-179. [DOI: 10.1111/j.1552-6909.2011.01332.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
39
|
Guenther MA, Bruder ED, Raff H. Effects of body temperature maintenance on glucose, insulin, and corticosterone responses to acute hypoxia in the neonatal rat. Am J Physiol Regul Integr Comp Physiol 2012; 302:R627-33. [DOI: 10.1152/ajpregu.00503.2011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
One of the biggest challenges of premature birth is acute hypoxia. Hypothermia during acute hypoxic periods may be beneficial. We hypothesized that prevention of hypothermia during neonatal hypoxia disrupts glucose homeostasis and places additional metabolic challenges on the neonate. Pups at PD2 and PD8 were exposed to 8% O2 for 3 h, during which they were allowed to either spontaneously cool or were kept isothermic. There was also a time control group that was subjected to normoxia and kept isothermic. Plasma glucose, insulin, C-peptide, corticosterone, and catecholamines were measured from samples collected at baseline, 1 h, 2 h, and 3 h. In postnatal day 2 (PD2) rats, hypoxia alone resulted in no change in plasma glucose by 1 h, an increase by 2 h, and a subsequent decrease below baseline values by 3 h. Hypoxia with isothermia in PD2 rats elicited a large increase in plasma insulin at 1 h. In PD8 rats, hypoxia with isothermia resulted in an initial increase in plasma glucose, but by 3 h, glucose had decreased significantly to below baseline levels. Hypoxia with and without isothermia elicited an increase in plasma corticosterone at both ages and an increase in plasma epinephrine in PD8 rats. We conclude that the insulin response to hypoxia in PD8 rats is associated with an increase in glucose similar to an adult; however, insulin responses to hypoxia in PD2 rats were driven by something other than glucose. Prevention of hypothermia during hypoxia further disrupts glucose homeostasis and increases metabolic challenges.
Collapse
Affiliation(s)
| | - Eric D. Bruder
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, and
| | - Hershel Raff
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, and
- Departments of Medicine, Surgery, and Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
40
|
Abstract
BACKGROUND The practice of glycemic control with intravenous insulin in critically ill patients has brought clinical focus on understanding the effects of hypoglycemia, especially in children. Very little is published on the impact of hypoglycemia in this population. We aimed to review the existing literature on hypoglycemia in critically ill neonates and children. METHODS We performed a systematic review of the literature up to August 2011 using PubMed, Ovid MEDLINE and ISI Web of Science using the search terms "hypoglycemia or hypoglyc*" and "critical care or intensive care or critical illness". Articles were limited to "all child (0-18 years old)" and "English". RESULTS A total of 513 articles were identified and 132 were included for review. Hypoglycemia is a significant concern among pediatric and neonatal intensivists. Its definition is complicated by the use of a biochemical measure (i.e., blood glucose) for a pathophysiologic problem (i.e., neuroglycopenia). Based on associated outcomes, we suggest defining hypoglycemia as <40-45 mg/dl in neonates and <60-65 mg/dl in children. Below the suggested threshold values, hypoglycemia is associated with worse neurological outcomes, increased intensive care unit stay, and increased mortality. Disruptions in carbohydrate metabolism increase the risk of hypoglycemia incritically ill children. Prevention of hypoglycemia, especially in the setting of intravenous insulin use, will be best accomplished by the combination of accurate measuring techniques, frequent or continuous glucose monitoring, and computerized insulin titration protocols. CONCLUSION Studies on hypoglycemia in critically ill children have focused on spontaneous hypoglycemia. With the current practice of maintaining blood glucose within a narrow range with intravenous insulin, the risk factors and outcomes associated with insulin-induced hypoglycemia should be rigorously studied to prevent hypoglycemia and potentially improve outcomes of critically ill children.
Collapse
|
41
|
Transitions in the early-life of late preterm infants: vulnerabilities and implications for postpartum care. J Perinat Neonatal Nurs 2012; 26:57-68. [PMID: 22293643 DOI: 10.1097/jpn.0b013e31823f8ff5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The focus of this article is on the transition of late preterm infants from hospital to home. The current state of literature related to mortality, morbidities, emergency department visits, and rehospitalization underscores the vulnerability of late preterm infants following discharge from hospital. Universal provision of postpartum care to late preterm infants is viewed as an environmental support intended to facilitate transition of these vulnerable infants from hospital to home. Gaps in provision of postpartum care of late preterm infants are situated within the discussion of guidelines and models of postpartum care (home vs clinic) of late preterm infants.
Collapse
|
42
|
Leone A, Ersfeld P, Adams M, Schiffer PM, Bucher HU, Arlettaz R. Neonatal morbidity in singleton late preterm infants compared with full-term infants. Acta Paediatr 2012; 101:e6-10. [PMID: 21895764 DOI: 10.1111/j.1651-2227.2011.02459.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIM The aim of this study was to test the hypothesis that singleton late preterm infants (34 0/7 to 36 6/7 weeks of gestation) compared with full-term infants have a higher incidence of short-term morbidity and stay longer in hospital. METHODS In this retrospective, multicentre study, electronic data of children born at five hospitals in Switzerland were recorded. Short-term outcome of late preterm infants was compared with a control group of full-term infants (39 0/7 to 40 6/7 weeks of gestation). Multiple gestations, pregnancies complicated by foetal malformations, maternal consumption of illicit drugs and infants with incomplete documentation were excluded. The results were corrected for gender imbalance. RESULTS Data from 530 late preterm and 1686 full-term infants were analysed. Compared with full-term infants, late preterm infants had a significant higher morbidity: respiratory distress (34.7% vs. 4.6%), hyperbilirubinaemia (47.7% vs. 3.4%), hypoglycaemia (14.3% vs. 0.6%), hypothermia (2.5% vs. 0.6%) and duration of hospitalization (mean, 9.9 days vs. 5.2 days). The risk to develop at least one complication was 7.6 (95% CI: 6.2-9.6) times higher among late preterm infants (70.8%) than among full-term infants (9.3%). CONCLUSION Singleton late preterm infants show considerably higher rate of medical complications and prolonged hospital stay compared with matched full-term infants and therefore need more medical and financial resources.
Collapse
Affiliation(s)
- A Leone
- Division of Neonatology, Department of Obstetrics and Gynecology, University Hospital Zurich, Switzerland.
| | | | | | | | | | | |
Collapse
|
43
|
Triage, not just for the emergency department: a discussion of the appropriate level of care for the transitioning infant. Neonatal Netw 2011; 30:99-103. [PMID: 21520683 DOI: 10.1891/0730-0832.30.2.99] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Determining the appropriate placement for infants experiencing a delay in transition or who require more intensive assessment, monitoring, and nursing care can be a challenge. Not all of these infants need to be admitted to the NICU. Since 1994, we have had a triage program to care for these infants. We define triage as a temporary (12 hours or fewer) level of care for monitoring, assessment, and intervention. This level of care is more intensive than in the newborn nursery, but the infant does not require an immediate NICU admission. Caring for these infants presents challenges in staffing, family-centered care, and reimbursement. This article shares information on the evolution of our triage program, its benefits to infants and their families, and how it is integrated into our NICU practices.
Collapse
|
44
|
Ramachandrappa A, Rosenberg ES, Wagoner S, Jain L. Morbidity and mortality in late preterm infants with severe hypoxic respiratory failure on extra-corporeal membrane oxygenation. J Pediatr 2011; 159:192-8.e3. [PMID: 21459387 PMCID: PMC3134553 DOI: 10.1016/j.jpeds.2011.02.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 01/18/2011] [Accepted: 02/07/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate morbidity, mortality, and associated risk factors in late preterm term infants (34-0/7 to 36-6/7 weeks) requiring extra-corporeal membrane oxygenation (ECMO). STUDY DESIGN We reviewed 21,218 neonatal ECMO runs in Extra-corporeal Life Support Organization registry data from 1986-2006. Infants were divided in 3 groups: late preterm (34-0/7 to 36-6/7 weeks), early-term (37-0/7 to 38-6/7 weeks), and full-term (39-0/7 to 42-6/7 weeks). RESULTS There were 14,528 neonatal ECMO runs that met inclusion criteria. Late preterm infants experienced the highest mortality rate on ECMO (late preterm, 26.2%; early-term, 18%; full-term, 11.2%; P < .001) and had longer ECMO runs; they also had higher rates of serious complications. Gestational age was a highly significant predictor for mortality. Late preterm infants with a primary diagnosis of sepsis and persistent pulmonary hypertension had 3-fold higher risk of mortality on ECMO than infants with meconium aspiration. CONCLUSION Late preterm infants treated with ECMO have higher morbidity and mortality rates than term infants. This underscores the need for special consideration of this vulnerable population in the diagnosis and treatment of hypoxic respiratory failure.
Collapse
Affiliation(s)
- Ashwin Ramachandrappa
- Department of Pediatrics, Division of Neonatology, Emory University, Atlanta, GA 30322, USA
| | | | | | | |
Collapse
|
45
|
|
46
|
|
47
|
Mally PV, Bailey S, Hendricks-Muñoz KD. Clinical issues in the management of late preterm infants. Curr Probl Pediatr Adolesc Health Care 2010; 40:218-33. [PMID: 20875895 DOI: 10.1016/j.cppeds.2010.07.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Prematurity is defined as birth before 37 weeks of gestation and is the major determinant of morbidity and mortality in newborns. The gestational ages known as near term or late preterm represent about 75% of preterm births and are the fastest growing subgroups of premature infants. These infants range in gestational age from 34 0/7 to 36 6/7 weeks and are at greater risk of morbidity, such as respiratory complications, temperature instability, hypoglycemia, kernicterus, feeding problems, neonatal intensive care unit admissions, and adverse neurological sequelae when compared with term infants. Long-term neurological and school-age outcomes of late preterm infants are concerns of major public health importance because even a minor increase in the rate of neurological disability and scholastic failure in this group can have a huge impact on the health care and educational systems. There is an urgent need to educate health care providers and parents about the vulnerability of late preterm infants, who are in need of diligent monitoring and care during the initial hospital stay and a comprehensive follow-up plan for post neonatal and long-term evaluations. Clinicians involved in the day-to-day care of late preterm infants, as well as those developing guidelines and recommendations, would benefit from having a clear understanding of the potential differences in risks faced by these infants, compared with their more mature counterparts.
Collapse
Affiliation(s)
- Pradeep V Mally
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | | | | |
Collapse
|
48
|
Bird TM, Bronstein JM, Hall RW, Lowery CL, Nugent R, Mays GP. Late preterm infants: birth outcomes and health care utilization in the first year. Pediatrics 2010; 126:e311-9. [PMID: 20603259 DOI: 10.1542/peds.2009-2869] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To distinguish the effects of late preterm birth from the complications associated with the causes of delivery timing, this study used propensity score-matching methods on a statewide database that contains information on both mothers and infants. METHODS Data for this study came from Arkansas Medicaid claims data linked to state birth certificate data for the years 2001 through 2005. We excluded all multiple births, infants with birth defects, and infants at <33 weeks of gestation. Late preterm infants (LPIs) (34 to 36 weeks of gestation) were matched with term infants (37-42 weeks of gestation) according to propensity scores, on the basis of infant, maternal, and clinical characteristics. RESULTS A total of 5188 LPIs were matched successfully with 15303 term infants. LPIs had increased odds of poor outcomes during their birth hospitalization, including a need for mechanical ventilation (adjusted odds ratio [aOR]: 1.31 [95% confidence interval [CI]: 1.01-1.68]), respiratory distress syndrome (aOR: 2.84 [95% CI: 2.33-3.45]), and hypoglycemia (aOR: 1.60 [95% CI: 1.26-2.03]). Outpatient and inpatient Medicaid expenditures in the first year were both modestly higher (outpatient, adjusted marginal effect: $108 [95% CI: $58-$158]; inpatient, $597 [95% CI: $528-$666]) for LPIs. CONCLUSIONS LPIs are at increased risk of poor health-related outcomes during their birth hospitalization and of increased health care utilization during their first year.
Collapse
Affiliation(s)
- T Mac Bird
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
| | | | | | | | | | | |
Collapse
|
49
|
Neonatal outcomes of late-preterm birth associated or not with intrauterine growth restriction. Obstet Gynecol Int 2010; 2010:231842. [PMID: 20339531 PMCID: PMC2843863 DOI: 10.1155/2010/231842] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 02/08/2010] [Indexed: 11/17/2022] Open
Abstract
Objective. To compare neonatal morbidity and mortality between late-preterm intrauterine growth-restricted (IUGR) and appropriate-for-gestational-age (AGA) infants of the comparable gestational ages (GAs). Methods. We retrospectively analyzed neonatal morbidity and mortality of 50 singleton pregnancies involving fetuses with IUGR delivered between 34 and 36 6/7 weeks of GA due to maternal and/or fetal indication. The control group consisted of 36 singleton pregnancies with spontaneous preterm delivery at the same GA, in which the infant was AGA. Categorical data were compared between IUGR and AGA pregnancies by X2 analysis and Fisher's exact test. Ordinal measures were compared using the Kruskal-Wallis test. Results. The length of stay of newborns in the nursery, as well as the need for and duration of hospitalization in the neonatal intensive care unit, was longer in the group with IUGR. Transient tachypnea of the newborn or apnea rates did not differ significantly between the IUGR and AGA groups. IUGR infants were found to be at a higher risk of intraventricular hemorrhage. No respiratory distress syndrome, pulmonary hemorrhage or bronchopulmonary dysplasia was observed in either group. The frequency of sepsis, thrombocytopenia and hyperbilirubinemia was similar in the two groups. Hypoglycemia was more frequent in the IUGR group. No neonatal death was observed. Conclusion. Our study showed that late-preterm IUGR infants present a significantly higher risk of neonatal complications when compared to late-preterm AGA infants.
Collapse
|
50
|
Tzur T, Weintraub AY, Sheiner E, Wiznitzer A, Mazor M, Holcberg G. Timing of elective repeat caesarean section: maternal and neonatal morbidity and mortality. J Matern Fetal Neonatal Med 2010; 24:58-64. [PMID: 20230324 DOI: 10.3109/14767051003678267] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Timing of elective repeat caesarean section should take into account both fetal and maternal considerations. The percentage of caesarean deliveries has dramatically increased during the last decades. It undoubtedly leads to an increase in the number of women having multiple caesarean sections. While maternal morbidity increases with increased number of caesarean sections, when compared with their term counterparts, late pre-term infants face increased morbidity. Establishing the optimal time of delivery for both mother and child is a major challenge faced by clinicians. The aim of this review is to better understand neonatal and maternal morbidity and mortality that are associated with elective repeat caesarean section, and to provide an educated decision regarding the optimal timing for elective repeat caesarean section.
Collapse
Affiliation(s)
- Tamar Tzur
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | | | | | | | | |
Collapse
|