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Oral characteristics and dietary habits of preterm children: A retrospective study using National Health Screening Program for Infants and Children. PLoS One 2023; 18:e0281896. [PMID: 36862725 PMCID: PMC9980808 DOI: 10.1371/journal.pone.0281896] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 02/03/2023] [Indexed: 03/03/2023] Open
Abstract
The rate of preterm birth is increasing worldwide and preterm infants are susceptible to oral health problems. Hence, this study aimed to investigate the effect of premature birth on dietary and oral characteristics as well as dental treatment experiences of preterm infants using a nationwide cohort study. Data was retrospectively analyzed from National Health Screening Program for Infants and Children (NHSIC) of the National Health Insurance Service of Korea. 5% sample of children born between 2008 and 2012 who completed first or second infant health screening were included and divided into full-term and preterm-birth groups. Clinical data variables such as dietary habits, oral characteristics, and dental treatment experiences were investigated and comparatively analyzed. Preterm infants showed significantly lower rates of breastfeeding at 4-6 months (p<0.001), delayed start of weaning food at 9-12 months (p<0.001), higher rates of bottle feeding at 18-24 months (p<0.001), poor appetite at 30-36 months (p<0.001) and higher rates of improper swallowing and chewing function at 42-53 months (p = 0.023) than full-term infants. Preterm infants also had eating habits leading to poor oral conditions and higher percentage of absence of dental visit compared to full-term infants (p = 0.036). However, dental treatments including 1-visit pulpectomy (p = 0.007) and 2-visit pulpectomy (p = 0.042) significantly decreased when oral health screening was completed at least once. The NHSIC can be an effective policy for oral health management in preterm infants.
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Neonatal Intensive Care Unit Admission Temperatures of Infants 1500 g or More: The Cold Truth. Adv Neonatal Care 2021; 21:214-221. [PMID: 32826410 DOI: 10.1097/anc.0000000000000787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Smaller preterm infants often receive extra attention with implementation of additional thermoregulation interventions in the delivery room. Yet, these bundles of interventions have largely remained understudied in larger infants. PURPOSE The purpose of this study was to evaluate initial (or admission) temperatures of infants born weighing 1500 g or more with diagnoses requiring admission to the neonatal intensive care unit (NICU). METHODS Retrospective medical record review of 388 infants weighing 1500 g or more admitted to the NICU between January 2016 and June 2017. RESULT In total, 42.5% of infants weighing 1500 g or more were admitted hypothermic (<36.5°C), 54.4% with a normothermic temperature, and 2.8% were hyperthermic. Of those infants admitted hypothermic, 30.4% had an admission temperature ranging from 36°C to 36.4°C and 12.1% had an admission temperature of less than 36°C. When compared with infants weighing less than 1500 g, who were born at the same institution and received extra thermal support interventions, there was a statistically significant difference (P < .001) between admission temperatures where infants less than 1500 g were slightly warmer (36.8°C vs 36.5°C). IMPLICATIONS FOR PRACTICE Ongoing admission temperature monitoring of all infants requiring NICU admission regardless of birth weight or admission diagnosis is important if we are going to provide the best support to decrease mortality and morbidity for this high-risk population. IMPLICATIONS FOR RESEARCH While this study examined short-term outcomes, effects on long-term outcomes were not addressed. Findings could be used to design targeted interventions to support thermal regulation for all high-risk infants. CONCLUSION Neonates admitted to the NICU weighing 1500 g or more are at high risk for developing hypothermia, similar to smaller preterm infants.
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Paes LS, Carvalho FH, Araujo Júnior E, Feitosa HN. Assessment of morbidity and mortality in newborns with late prematurity: experience of a reference maternity in the northeast of Brazil. Minerva Obstet Gynecol 2021; 74:270-278. [PMID: 33876899 DOI: 10.23736/s2724-606x.21.04734-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Late preterm infants show high rates of adverse perinatal outcomes. The aim of this study is to assess the morbidity and mortality of newborns (NBs) with late preterm birth in a reference maternity hospital in northeastern Brazil. METHODS Retrospective cohort study from March 1 to July 15, 2017. A total of 204 NBs with gestational age between 34 and 36 weeks and six days were evaluated and compared to 205 full-term NBs (39 and 40 weeks and six days). Perinatal outcomes including neonatal morbidity were evaluated. The Student's t and ANOVA tests were used for normal variables, and the Wilcoxon, Mann-Whitney and Kruskal-Wallis tests for non-normal variables. RESULTS Late preterm infants showed significant higher rates of hypothermia, hypoglycemia, respiratory distress syndrome, jaundice in need of phototherapy (67.6%), admission to the neonatal intensive care unit (ICU), and difficulty breastfeeding compared to full-term NBs (p<0.001). Respiratory distress was the main indication for the admission of late preterm infants (p<0.001) to neonatal ICU. Late preterm infants had a longer hospital stay (6.9 vs. 3.7 days, p<0.001). There were three deaths in the group of late preterm NBs, and none in the group of term NBs. CONCLUSIONS Late preterm NBs presented higher rates of morbidity and mortality when compared to full-term NBs.
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Affiliation(s)
- Liliana S Paes
- Department of Maternal and Child Health, Federal University of Ceará (UFC), Fortaleza-CE, Brazil
| | - Francisco H Carvalho
- Department of Maternal and Child Health, Federal University of Ceará (UFC), Fortaleza-CE, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil -
| | - Helvécio N Feitosa
- Department of Maternal and Child Health, Federal University of Ceará (UFC), Fortaleza-CE, Brazil
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Khasawneh W, Alyousef R, Akawi Z, Al-Dhoon A, Odat A. Maternal and Perinatal Determinants of Late Hospital Discharge Among Late Preterm Infants; A 5-Year Cross-Sectional Analysis. Front Pediatr 2021; 9:685016. [PMID: 34222151 PMCID: PMC8242188 DOI: 10.3389/fped.2021.685016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Although late preterm infants (LPIs) account for the majority of preterm births, they are mistakenly labelled and treated as "near term." Whether longer initial hospital stay improves their outcomes and lowers readmission is controversial. The aim of this study is to identify maternal and perinatal factors associated with longer hospital stay and to assess the rate of readmission. Methods: The medical records of LPIs delivered at an academic center in Jordan over a 5-year period were reviewed. They were divided according to their initial hospital stay into: Early discharge group (ED, ≤ 3 days) and late discharge group (LD, > 3 days). Maternal and perinatal factors associated with > 3-day hospital stay were reported. The rate of readmission was compared between both groups. Results: 2236 LPIs were included in the analysis representing 13% of total births and 81% of premature births. LD group constituted 54%. A thousand two hundred forty three (56%) required admission to NICU. Factors associated with longer hospital stay included maternal prolonged rupture of membranes (AOR 1.9, 95% C.I 1.5, 2.4, p 0.000), C-section delivery (AOR 2.4, 95% C.I 1.9, 3, p 0.001), <35-week gestation (AOR 3.8, 95% C.I 2.6, 5, p 0.000), small-for-gestational age (AOR 1.9, 95% C.I 1.1, 3.8, p 0.03), birthweight <2,500 g (AOR 1.3, 95% C.I 1.1, 1.6, p 0.02), NICU admission (AOR 6.3, 95% C.I 3.4, 11.5, p 0.000), RDS (AOR 2.3, 95% C.I 1.5, 3.6, p 0.005), surfactant therapy (AOR 5, 95% C.I 1.9, 13.5, p 0.001), use of CPAP (AOR 1.7, 95% C.I 1.2, 2.2, p 0.001), jaundice (AOR 11.2, 95% C.I 7.7, 16.2, p 0.000), and sepsis (AOR 10.3, 95% C.I 4.8, 22, p 0.000). Readmission rate was 19% among the LD group and 13% among the ED group. Conclusion: LPIs are at high risk for developing prematurity-related morbidities and the duration of their initial hospital stay can be anticipated based on certain predisposing maternal and perinatal factors. Late discharge of LPIs does not lower the rate of readmission.
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Affiliation(s)
- Wasim Khasawneh
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Rahaf Alyousef
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Zuhour Akawi
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Areen Al-Dhoon
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ahlam Odat
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Yu YH, Wang L, Huang L, Wang LL, Huang XY, Fan XF, Ding YJ, Zhang CY, Liu Q, Sun AR, Zhao YH, Yao G, Li C, Liu XX, Wu JC, Yang ZY, Chen T, Ren XY, Li J, Bi MR, Peng FD, Geng M, Qiu BP, Zhao RM, Niu SP, Zhu RX, Chen Y, Gao YL, Deng LP. Association between admission hypothermia and outcomes in very low birth weight infants in China: a multicentre prospective study. BMC Pediatr 2020; 20:321. [PMID: 32600275 PMCID: PMC7322890 DOI: 10.1186/s12887-020-02221-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 06/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background The objective of this prospective, multicentre, observational cohort study was to evaluate the association between admission hypothermia and neonatal outcomes in very low-birth weight (VLBW) infants in multiple neonatal intensive care units (NICUs) in China. Methods Since January 1, 2018, a neonatal homogeneous cooperative research platform-Shandong Neonatal Network (SNN) has been established. The platform collects clinical data in a prospective manner on preterm infants with birth weights (BWs) < 1500 g and gestational ages (GAs) < 34 weeks born in 28 NICUs in Shandong Province. These infants were divided into normothermia, mild or moderate/severe hypothermia groups according to the World Health Organization (WHO) classifications of hypothermia. Associations between outcomes and hypothermia were tested in a bivariate analysis, followed by a logistic regression analysis. Results A total of 1247 VLBW infants were included in this analysis, of which 1100 infants (88.2%) were included in the hypothermia group, 554 infants (44.4%) in the mild hypothermia group and 546 infants (43.8%) in the moderate/severe hypothermia group. Small for gestational age (SGA), caesarean section, a low Apgar score at 5 min and intubation in the delivery room (DR) were related to admission hypothermia (AH). Mortality was the lowest when their admission temperature was 36.5 ~ 37.5 °C, and after adjustment for maternal and infant characteristics, mortality was significantly associated with AH. Compared with infants with normothermia (36.5 ~ 37.5 °C), the adjusted ORs of all deaths increased to 4.148 (95% CI 1.505–11.437) and 1.806 (95% CI 0.651–5.009) for infants with moderate/severe hypothermia and mild hypothermia, respectively. AH was also associated with a high likelihood of respiratory distress syndrome (RDS), intraventricular haemorrhage (IVH), and late-onset neonatal sepsis (LOS). Conclusions AH is still very high in VLBW infants in NICUs in China. SGA, caesarean section, a low Apgar score at 5 min and intubation in the DR were associated with increased odds of hypothermia. Moderate/severe hypothermia was associated with mortality and poor outcomes, such as RDS, IVH, LOS.
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Affiliation(s)
- Yong-Hui Yu
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University and Shandong University, No. 234, Jingwu Road, Huai Yin District, Jinan, 250021, Shandong, China.
| | - Li Wang
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University and Shandong University, No. 234, Jingwu Road, Huai Yin District, Jinan, 250021, Shandong, China
| | - Lei Huang
- Shandong Provincial Maternity and Child Health Care Hospital, Jinan, China
| | - Li-Ling Wang
- Qianfo Shan Hospital Affiliated to Shandong University, Jinan, China
| | | | - Xiu-Fang Fan
- Jinan Maternity and Child Health Care Hospital, Jinan, China
| | | | - Cheng-Yuan Zhang
- Weifang Maternity and Child Health Care Hospital, Weifang, China
| | - Qiang Liu
- Linyi People's Hospital, Linyi, China
| | - Ai-Rong Sun
- Linyi Women's and Children's Hospital, Linyi, China
| | - Yue-Hua Zhao
- Affiliated Hospital of Weifang Medical College, Weifang, China
| | - Guo Yao
- Taian Central Hospital, Taian, China
| | - Cong Li
- Liaocheng People's Hospital, Liaocheng, China
| | | | - Jing-Cai Wu
- Zaozhuang Maternity and Child Health Care Hospital, Zaozhuang, China
| | - Zhen-Ying Yang
- Taian Maternity and Child Health Care Hospital, Taian, China
| | - Tong Chen
- Dongying People's Hospital, Dongying, China
| | - Xue-Yun Ren
- Affiliated Hospital of Jining Medical College, Jining, China
| | - Jing Li
- The Second Affiliated Hospital of Shandong First Medical University, Jinan, China
| | | | - Fu-Dong Peng
- Liaocheng Second People's Hospital, Liaocheng, China
| | - Min Geng
- Jinan Second Maternity and Child Health Care Hospital, Jinan, China
| | | | | | - Shi-Ping Niu
- Zibo Maternity and Child Health Care Hospital, Zibo, China
| | - Ren-Xia Zhu
- People's Hospital of Linzi District, Zibo, China
| | - Yao Chen
- Central Hospital of Shandong Provincial Affiliated to Shandong University, Jinan, China
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Algameel A, Elhawary M, Amin S, Abd Elmenem M. Outcome of late preterm newborns in Upper Egypt. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2020. [DOI: 10.1186/s43054-020-00023-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The incidence of preterm births is increasing and has become a global health concern. This study aimed to compare the outcome of late preterm (LPT) to full term (FT) neonates at two large hospitals in Upper Egypt.
Results
Out of 250 newborns included in the study, 180 (72%) were FT and 70 (28%) were LPT. More than half of the LPT newborns (52.9%) were admitted to the neonatal intensive care unit (NICU), compared with 26.7% of FT newborns. Delivery of LPT was associated with an increased risk of neonatal morbidity, including jaundice requiring phototherapy (34.3% vs. 7.8%), respiratory morbidities (32.9% vs. 13.9%), hypoglycemia (8.6% vs. 1.7 %), and convulsions (4.3% vs. 0.6%).
Conclusions
LPT neonates were more susceptible to suffer from jaundice and respiratory distress among other morbidities. They also had a higher rate of NICU admission, longer duration of NICU stay, as well as a higher mortality rate. The best treatment of late prematurity is to prevent it. Public and professional awareness of the problems associated with late prematurity should be highlighted. Follow-up programs for early detection and intervention for long term complications are recommended.
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Dib S, Wells JCK, Fewtrell M. Mother And late Preterm Lactation Study (MAPLeS): a randomised controlled trial testing the use of a breastfeeding meditation by mothers of late preterm infants on maternal psychological state, breast milk composition and volume, and infant behaviour and growth. Trials 2020; 21:318. [PMID: 32264947 PMCID: PMC7137320 DOI: 10.1186/s13063-020-4225-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 03/03/2020] [Indexed: 11/19/2022] Open
Abstract
Background Late preterm infants suffer from more complications and are less likely to be breastfed compared to term infants and their mothers experience higher levels of stress than mothers with term infants. The physiological or hormonal responses that influence milk ejection, milk production, and/or maternal behaviour are possible mechanisms by which maternal distress could negatively influence breastfeeding success. Maternal mood might also affect infant behaviour (feeding, sleeping, and crying) through changes in milk volume and composition, and consequently breastfeeding success and infant growth. Previous research, using relaxation therapy in 64 Malaysian first-time mothers breastfeeding their full-term infants, demonstrated that the therapy was effective in reducing maternal stress and improving infant growth. We hypothesise that expected benefits are even greater in a more vulnerable population where additional breastfeeding support is especially needed, such as in mothers of late preterm infants. Methods/design This protocol describes our randomised controlled trial that tests whether a breastfeeding meditation audio reduces maternal stress in mothers of late preterm infants in London. Home visits will be conducted at 2–3 and 6–8 weeks post-delivery. Participants will be randomised to a control group or an intervention group, where mothers will be asked to listen to a meditation tape on a daily basis while breastfeeding. The main outcomes of the intervention will be maternal stress markers and infant weight Z-score. Potential mediators will be the secondary outcomes and include breast milk macronutrient and hormone levels (ghrelin, leptin, cortisol, and adiponectin), milk volume assessed by 48-h test-weighing, and maternal engagement with the infant. Infant behaviour, including crying and sleeping, and infant appetite will be evaluated. Data about other mediators such as maternal perception of milk supply and salivary oxytocin will be collected. Discussion We hypothesise that the use of the breastfeeding meditation will reduce maternal stress and consequently improve infant growth mediated by changes in milk composition and volume and maternal behaviour. This study will allow us to understand the mother–infant factors that influence breastfeeding in late preterm infants and potentially identify a method that could improve mother, infant, and breastfeeding outcomes. Trial registration ClinicalTrials.gov, NCT03791749. Registered 1 January 2019.
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Affiliation(s)
- Sarah Dib
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK.
| | - Jonathan C K Wells
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Mary Fewtrell
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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Ericksen K, Fogel J, Verma RP. Placental histopathology in late preterm infants: clinical implications. Clin Exp Pediatr 2020; 63:48-51. [PMID: 31431602 PMCID: PMC7029669 DOI: 10.3345/kjp.2019.00038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/13/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The etiopathogenesis of late preterm (LPT) birth is undetermined. Placental histopathology, which reflects an adverse intrauterine environment and is reportedly associated with preterm labor and neonatal morbidities, has not been studied in LPT infants. PURPOSE We investigated placental pathological lesion as markers of an adverse intrauterine environment during LPT labor. METHODS This retrospective case-control study compared placental histopathological and clinical variables between LPT and term neonates. Placental variables included chorioamnionitis, funisitis, hemorrhage, abruption, infarction, calcification, and syncytial knots. Maternal variables included age, substance abuse, pregnancyassociated diabetes mellitus and hypertension, duration of rupture of membrane, antibiotic use, and magnesium sulfate, whereas, those of neonates included gestational age, birth weight, race, sex, and Apgar scores. Standard statistical proedures were applied to analyze the data. RESULTS Chorioamnionitis (50% vs. 17.8%, P<0.001) and funisitis (20% vs. 4.4%, P=0.002) were more common in term infants. Placental infarction rate was insignificantly higher in LPT infants (25.6% vs. 14.3%, P=0.08). The mothers in the LPT group were older (30.4 years vs. 28.1 years, P=0.05; odds ratio [OR], 1.06; 95% confidence interval [CI], 0.998-1.12, P=0.056) and more often suffered from hypertension (28.9 vs. 12.9 %, P=0.02), and received magnesium sulfate (48.9 vs. 20%, P< 0.001; OR, 2.86; 95% CI, 1.12-7.29, P<0.05). Duration of rupture of membrane was higher in term infants (13.6 hours vs. 9.1 hours, P<0.001). Chorioamnionitis (OR, 0.33; 95% CI, 0.13-0.79; P<0.05) was associated with a lower risk of LPT delivery. CONCLUSION Placental infection is not a risk factor for LPT births. There is a nonsignificant predominance of vascular anomalies in LPT placentas. Higher maternal age, magnesium sulfate therapy, and maternal hypertension are clinical risk factors for LPT labor.
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Affiliation(s)
- Kristina Ericksen
- Department of Pediatrics, Nassau University Medical Center, East Meadow, NY, USA
| | | | - Rita P Verma
- Department of Pediatrics, Nassau University Medical Center, East Meadow, NY, USA
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Mojtahedi SY, Izadi A, Seirafi G, Khedmat L, Tavakolizadeh R. Risk Factors Associated with Neonatal Jaundice: A Cross-Sectional Study from Iran. Open Access Maced J Med Sci 2018; 6:1387-1393. [PMID: 30159062 PMCID: PMC6108787 DOI: 10.3889/oamjms.2018.319] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 07/23/2018] [Accepted: 07/07/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Neonatal jaundice is one of the main causes of the patient's admission in the neonatal period and is potentially linked to morbidity. AIM This study aimed to determine the possible risk factors for neonatal jaundice. METHODS We investigated the case of infants who were admitted to the neonatal department of Ziyaeian hospital and Imam Khomeini Hospital for jaundice. Simple random sampling was used to evaluate variables related to maternal and neonatal predisposing factors based on the medical records and clinical profiles. All variables in this study were analysed using SPSS software. RESULTS In this study, about 200 mothers and neonates were examined. Our findings depicted that mother's WBC, Hb, PLT, and gestational age were associated with jaundice (P < 0.05). Furthermore, there were significant relationships between different degrees of bilirubin with TSH, T4 levels and G6PD (P < 0.05). In fact, TSH, T4 levels and G6PD were found to be linked to neonatal hyperbilirubinemia. The risk factors for jaundice in our study population comprise some predisposing factors such as WBC, Hb, PLT, gestational age, TSH, and T4 levels, as well as G6PD. Neonates at risk of jaundice are linked to some maternal and neonatal factors that can provide necessary interventions to reduce the burden of the disease. Therefore, identification of associated factors can facilitate early diagnosis, and reduce subsequent complications. CONCLUSION Neonatal jaundice should be considered as the main policy in all health care settings of the country. Therefore, identification of factors affecting the incidence of jaundice can be effective in preventing susceptible predisposing factors in newborns and high-risk mothers.
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Affiliation(s)
- Sayed Yousef Mojtahedi
- Department of Pediatrics, Ziyaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Izadi
- Department of Pediatric Infection Disease, Tehran University of Medical Science, Tehran, Iran
| | - Golnar Seirafi
- School of Medicine, Ziyaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Khedmat
- Department of Community Medicine, School of Medicine, Tehran University of Medical Science, Tehran, Iran
- Health Management Research Center and Department of Community Medicine, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Reza Tavakolizadeh
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
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Valizadeh L, Mahallei M, Safaiyan A, Ghorbani F, Peyghami M. Comparison of the Effect of Plastic Cover and Blanket on Body Temperature of Preterm Infants Hospitalized in NICU: Randomized Clinical Trial. J Caring Sci 2017; 6:163-172. [PMID: 28680870 PMCID: PMC5488671 DOI: 10.15171/jcs.2017.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/11/2016] [Indexed: 11/21/2022] Open
Abstract
Introduction: Preterm infants are unable to regulate their
body temperature and there are insufficient research evidences on different kinds of
covers for hospitalized preterm infants; therefore, the present study was conducted with
the aim of comparing the effects of plastic and blanket covers on the body temperature of
preterm infants under radiant warmer. Methods: This randomized cross-over clinical trial was
carried out upon 80 infants with the gestational age of 28-30 weeks and birth weight of
800- 1250 gr who were in Neonatal Intensive Care Unit on the second day of their
hospitalization. The study lasted for two days. In group 1, the plastic cover was used
during the first day of the study while the blankets were used during the second day.
Infants’ heads were kept out of the cover and coated with a hat. In group 2, the plastic
cover was used during the first day of the study while the blanket was used during second
day. Digital thermometer was used to measure infants’ axillary temperature. The data was
analyzed using SPSS ver 13 and MiniTab software. Descriptive statistics, (Mean (SE),
95%CI) and inferential statistics (Repeated measurement and ANCOVA tests) were used. Results: The mean body temperature of the infants in the
group covered with the plastic was calculated to be higher and the warmer was set on low
temperature. Conclusion: Using plastic cover during the first few days of
hospitalization in NICU resulted in regulation of preterm infants’ body temperature.
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Affiliation(s)
- Leila Valizadeh
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid Mahallei
- Department of Pediatrics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdolrasoul Safaiyan
- Department of Biostatistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Ghorbani
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Peyghami
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Nguyen VB, De Matteo R, Harding R, Stefanidis A, Polglase GR, Black MJ. Experimentally Induced Preterm Birth in Sheep Following a Clinical Course of Antenatal Betamethasone: Effects on Growth and Long-Term Survival. Reprod Sci 2016; 24:1203-1213. [DOI: 10.1177/1933719116681514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Vivian B. Nguyen
- Development and Stem Cells Program, Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
| | - Robert De Matteo
- Development and Stem Cells Program, Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
| | - Richard Harding
- Development and Stem Cells Program, Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
| | - Aneta Stefanidis
- Department of Physiology, Monash University, Melbourne, Victoria, Australia
| | - Graeme R. Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - M. Jane Black
- Development and Stem Cells Program, Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
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Darcy-Mahoney A, Minter B, Higgins M, Guo Y, Williams B, Head Zauche LM, Birth K. Probability of an Autism Diagnosis by Gestational Age . NEWBORN AND INFANT NURSING REVIEWS : NAINR 2016; 16:322-326. [PMID: 28989329 PMCID: PMC5627777 DOI: 10.1053/j.nainr.2016.09.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Early preterm infants (EPT) (<33 6/7 weeks) are at increased risk for autism spectrum disorders (ASDs) but prevalence estimates vary widely across studies. Furthermore, there are very few studies addressing the association between late preterm (LPT) births (34-36 6/7 weeks) and ASDs. To address the question of whether LPT infants carry the same risk for ASDs as full-term infants, this study aimed to estimate the relative probability of an ASD diagnosis using Bayes rule. A retrospective cohort analysis of 406 children was undertaken to look at gestational age, ASDs, and birth history. The application of Bayes rule was used, given that there is not sufficient information about the joint probabilities related to prematurity and autism. Using the estimated gestational age proportions within ASD diagnosis, plus national estimates of ASDs, probabilities for ASDs within a given gestational age were calculated. Among these 406 children with ASDs, 6.7% were EPT and 10.6% were LPT. In comparison to full term, EPT children are at 1.9 multiplicative increase in risk (95% CI [1.3, 2.5]). While the probability of ASDs for LPT children was higher than that for term, the estimated relative risk of the LPT infants was not statistically significant (95% CI [0.9, 1.5]). EPT infants were significantly more likely to be diagnosed with ASDs compared to their term peers. While the relative probability of ASD diagnosis among children born LPT was not statistically significant in this limited sample, the results indicate a possible elevated risk. A larger cohort is needed to adequately estimate this risk.
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Affiliation(s)
- Ashley Darcy-Mahoney
- George Washington University School of Nursing, 2030 M St NW Suite 300, Washington, DC 20052
- George Washington University, Autism and Neurodevelopmental Institute, 2121 Eye Street NW Suite 601, Washington, DC 20052
| | - Bonnie Minter
- Marcus Autism Center, Children’s Healthcare of Atlanta, 1920 Briarcliff Road, Atlanta, GA 30329, United States
| | - Melinda Higgins
- Emory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Rd., Atlanta, GA 30322, United States
| | - Ying Guo
- Emory University Rollins School of Public Health, 1518 Clifton Rd., Atlanta, GA 30322, United States
| | - Bryan Williams
- Emory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Rd., Atlanta, GA 30322, United States
| | - Lauren M. Head Zauche
- Emory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Rd., Atlanta, GA 30322, United States
| | - Katie Birth
- Children’s Healthcare of Atlanta, 1405 Clifton Rd., Atlanta, GA 30329, United States
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Baker B. Evidence-based practice to improve outcomes for late preterm infants. J Obstet Gynecol Neonatal Nurs 2015; 44:127-134. [PMID: 25782192 DOI: 10.1111/1552-6909.12533] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Infants born between 34 weeks 0 days to 36 weeks 6 days gestation have been identified as late preterm infants (LPIs) and account for 70% of preterm births and 9% of all births. The rise in elective deliveries in the past decade is believed to have contributed to the number of late preterm births. An interprofessional team including labor and delivery, neonatal intensive care, and postpartum care providers collaborated to address this issue at an urban academic medical center.
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ADHD and developmental speech/language disorders in late preterm, early term and term infants. J Perinatol 2015; 35:660-4. [PMID: 25836321 DOI: 10.1038/jp.2015.28] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/13/2015] [Accepted: 02/10/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We sought to compare the long-term neurodevelopmental outcomes of late preterm, early term and term infants while controlling for a wide range of maternal complications and comorbidities. STUDY DESIGN Data for the study was obtained from the South Carolina Medicaid claims and vital records databases from 1 January 2000 to 31 December 2003. We included infants weighing between 1500 and 4500 g, born between 34 0/7 and 41 6/7 weeks, and with no congenital anomalies. Outcome measures were based on the presence of ICD-9-CM codes for attention deficit hyperactivity disorders and developmental speech or language disorders. RESULT A total of 3270 late preterm (LPIs), 11,527 early term (ETIs) and 24,005 term infants met the eligibility criteria. Rates for all outcome variables were statistically significant and elevated for LPI, but adjusted hazard ratios (AHRs) were only significant for the risk of developmental speech and/or language delay (LPI: AHR 1.36 95% confidence interval (CI) 1.23 to 1.50; ETI: AHR 1.27 95% CI 1.17 to 1.37). CONCLUSION Late preterm and early term deliveries have adverse long-term neurodevelopmental outcomes, and these outcomes should be considered when determining the timing of delivery.
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Abstract
Preterm births account for 12.5% of all births in the United States. The preterm birth rate has increased by 33% over the last 2 decades. Late and premature infants do not develop the serious and chronic conditions of the extreme premature infant. However, there is growing evidence that these infants are not as healthy as previously thought and do in fact have an increase in morbidity and mortality compared with term infants. This article summarizes the epidemiology of late preterm infants and the associated morbidities associated with their prematurity.
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Affiliation(s)
- Michael J Horgan
- Division of Neonatology, Department of Pediatrics, Children's Hospital at Albany Medical Center, Albany Medical College, MC-101, Albany, NY 12208, USA.
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Gázquez Serrano I, Arroyos Plana A, Díaz Morales O, Herráiz Perea C, Holgueras Bragado A. Antenatal corticosteroid therapy and late preterm infant morbidity and mortality. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.anpede.2014.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Corticoterapia prenatal y morbimortalidad del prematuro tardío: estudio prospectivo. An Pediatr (Barc) 2014; 81:374-82. [DOI: 10.1016/j.anpedi.2014.01.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/20/2014] [Accepted: 01/27/2014] [Indexed: 01/08/2023] Open
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Holvey N. The imperative of implementing delayed cord clamping to improve maternal and neonatal outcomes. ACTA ACUST UNITED AC 2014. [DOI: 10.12968/bjom.2014.22.9.651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nicola Holvey
- Student midwife, University of West London Wexham Park Hospital
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Holden MS, Hopper A, Slater L, Asmerom Y, Esiaba I, Boskovic DS, Angeles DM. Urinary Hypoxanthine as a Measure of Increased ATP Utilization in Late Preterm Infants. INFANT, CHILD & ADOLESCENT NUTRITION 2014; 6:240-249. [PMID: 26413195 PMCID: PMC4581456 DOI: 10.1177/1941406414526618] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the effect of neonatal morbidity on ATP breakdown in late preterm infants. STUDY DESIGN Urinary hypoxanthine concentration, a marker of ATP breakdown, was measured from 82 late preterm infants on days of life (DOL) 3 to 6 using high-performance liquid chromatography. Infants were grouped according to the following diagnoses: poor nippling alone (n = 8), poor nippling plus hyperbilirubinemia (n = 21), poor nippling plus early respiratory disease (n = 26), and respiratory disease alone (n = 27). RESULTS Neonates with respiratory disease alone had significantly higher urinary hypoxanthine over DOL 3 to 6 when compared with neonates with poor nippling (P = .020), poor nippling plus hyperbilirubinemia (P < .001), and poor nippling plus early respiratory disease (P = .017). Neonates with poor nippling who received respiratory support for 2 to 3 days had significantly higher hypoxanthine compared with infants who received respiratory support for 1 day (P = .017) or no days (P = .007). CONCLUSIONS These findings suggest that respiratory disorders significantly increase ATP degradation in late premature infants.
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Affiliation(s)
- Megan S Holden
- Departments of Basic Sciences (MSH, LS, YA, DSB, DA) and Pediatrics (AH), Loma Linda University School of Medicine; Department of Earth and Biological Sciences, Loma Linda University School of Public Health (IE), Loma Linda, California
| | - Andrew Hopper
- Departments of Basic Sciences (MSH, LS, YA, DSB, DA) and Pediatrics (AH), Loma Linda University School of Medicine; Department of Earth and Biological Sciences, Loma Linda University School of Public Health (IE), Loma Linda, California
| | - Laurel Slater
- Departments of Basic Sciences (MSH, LS, YA, DSB, DA) and Pediatrics (AH), Loma Linda University School of Medicine; Department of Earth and Biological Sciences, Loma Linda University School of Public Health (IE), Loma Linda, California
| | - Yayesh Asmerom
- Departments of Basic Sciences (MSH, LS, YA, DSB, DA) and Pediatrics (AH), Loma Linda University School of Medicine; Department of Earth and Biological Sciences, Loma Linda University School of Public Health (IE), Loma Linda, California
| | - Ijeoma Esiaba
- Departments of Basic Sciences (MSH, LS, YA, DSB, DA) and Pediatrics (AH), Loma Linda University School of Medicine; Department of Earth and Biological Sciences, Loma Linda University School of Public Health (IE), Loma Linda, California
| | - Danilo S Boskovic
- Departments of Basic Sciences (MSH, LS, YA, DSB, DA) and Pediatrics (AH), Loma Linda University School of Medicine; Department of Earth and Biological Sciences, Loma Linda University School of Public Health (IE), Loma Linda, California
| | - Danilyn M Angeles
- Departments of Basic Sciences (MSH, LS, YA, DSB, DA) and Pediatrics (AH), Loma Linda University School of Medicine; Department of Earth and Biological Sciences, Loma Linda University School of Public Health (IE), Loma Linda, California
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Freitas PD, Marques SR, Alves TB, Takahashi J, Kimura AF. Changes in physiological and behavioral parameters of preterm infants undergoing body hygiene: a systematic review. Rev Esc Enferm USP 2014; 48 Spec No:178-83. [DOI: 10.1590/s0080-623420140000600025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 07/10/2014] [Indexed: 11/22/2022] Open
Abstract
Objective To verify the effect of bathing on the body temperature of preterm infants (PTI). Method Systematic review conducted in the following bibliographic electronic sources: Biblioteca Virtual em Saúde/Lilacs (BVS), Cumulated Index of Nursing and Allied Health Literature (CINAHL), Cochrane Library, Google Scholar, PubMed, SCOPUS and Web of Science, using a combination of search terms, keywords and free terms. The review question was adjusted to the PICO acronym (Patient/population, Intervention, Control/comparative intervention, Outcome). The selected publications were evaluated according to levels of evidence and grades of recommendation for efficacy/effectiveness studies, as established by the Joanna Briggs Institute. Results Eight hundred and twenty four (824) publications were identified and four studies met the inclusion criteria, of which three analyzed the effect of sponge baths and the effect of immersion baths. Conclusion Sponge baths showed a statistically significant drop in body temperature, while in immersion baths the body temperature remained stable, although they studied late preterm infants.
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Mahoney AD, Jain L. Respiratory disorders in moderately preterm, late preterm, and early term infants. Clin Perinatol 2013; 40:665-78. [PMID: 24182954 DOI: 10.1016/j.clp.2013.07.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Even when it is just a few weeks before term gestation, early birth has consequences, resulting in higher morbidity and mortality. Respiratory issues related to moderate prematurity include delayed neonatal transition to air breathing, respiratory distress resulting from delayed fluid clearance (transient tachypnea of the newborn), surfactant deficiency (respiratory distress syndrome), and pulmonary hypertension. Management approaches emphasize appropriate respiratory support to facilitate respiratory transition and minimize iatrogenic injury. Studies are needed to determine the impact of respiratory distress coupled with mild-moderate prematurity on long-term outcome.
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Affiliation(s)
- Ashley Darcy Mahoney
- Nell Hodgson Woodruff School of Nursing, Emory University School of Nursing, 1520 Clifton Road, Atlanta, GA 30322, USA; South Dade Neonatology, Miami, FL, USA.
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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.
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Affiliation(s)
- Rakesh Sahni
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, 3959 Broadway, MSCHN-1201, New York, NY 10032, USA
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23
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Scrafford CG, Mullany LC, Katz J, Khatry SK, LeClerq SC, Darmstadt GL, Tielsch JM. Incidence of and risk factors for neonatal jaundice among newborns in southern Nepal. Trop Med Int Health 2013; 18:1317-28. [PMID: 24112359 DOI: 10.1111/tmi.12189] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To quantify the incidence of and risk factors for neonatal jaundice among infants referred for care from a rural, low-resource, population-based cohort in southern Nepal. METHODS Study participants were 18,985 newborn infants born in Sarlahi District in southern Nepal from May 2003 through January 2006 who participated in a cluster-randomised, placebo-controlled, community-based trial to evaluate the effect of newborn chlorhexidine cleansing on neonatal mortality and morbidity. Jaundice was assessed based on visual assessment of the infant by a study worker and referral for care. Adjusted relative risks (RR) were estimated to identify risk factors for referral for neonatal jaundice using Poisson regression. RESULTS The incidence of referral for neonatal jaundice was 29.3 per 1000 live births (95% confidence interval: 26.9, 31.7). Male sex, high birth weight, breastfeeding patterns, warm air temperature, primiparity, skilled birth attendance, place of delivery, prolonged labour, oil massage, paternal education and ethnicity were significant risk factors (P-values < 0.01). After multivariable adjustment, sex, birth weight, difficulty feeding, prolonged labour, primiparity, oil massage, ambient air temperature and ethnicity remained important factors. Among infants with difficulty feeding, exclusive breastfeeding was a risk factor for neonatal jaundice, whereas exclusive breastfeeding was protective among infants with no report of difficulty feeding. CONCLUSIONS Several known risk factors for neonatal jaundice in a low-resource setting were confirmed in this study. Unique observed associations of jaundice with ambient air temperature and oil massage may be explained by the opportunity for phototherapy based on the cultural practices of this study population. Future research should investigate the role of an infant's difficulty in feeding as a potential modifier in the association between exclusive breastfeeding and jaundice.
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Affiliation(s)
- Carolyn G Scrafford
- Department of International Health, Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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25
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Should patients with documented fetal lung immaturity after 34 weeks of gestation be treated with steroids? Am J Obstet Gynecol 2012; 207:222.e1-4. [PMID: 22749409 DOI: 10.1016/j.ajog.2012.06.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 05/03/2012] [Accepted: 06/11/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether corticosteroid administration after 34 weeks of gestation is associated with improved neonatal outcome in the presence of fetal lung immaturity. STUDY DESIGN We conducted a retrospective cohort study of women who underwent amniocentesis to determine fetal lung maturity from 34-37 weeks of gestation. Patients with negative results (167 women) received steroids based on physician preference and were categorized into 2 groups: study group treated with betamethasone (n = 83 women) and control group in which patients did not receive betamethasone therapy (n = 84 women). The 2 groups were compared with respect to neonatal outcomes. Composite neonatal morbidity was defined as the presence of respiratory distress syndrome, transient tachypnea of the newborn infant, or the need for respiratory support. RESULTS The rate of composite neonatal morbidity was significantly lower among infants who were exposed to steroids compared with the control group (8.4% vs 21%; P = .02). Multiple regression analysis revealed that corticosteroid administration was associated independently with the composite morbidity outcome. CONCLUSION Antenatal steroid administration after 34 weeks of gestation is associated with improved neonatal outcome and should be considered when fetal lung immaturity is documented.
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Bueno M, Stevens B, de Camargo PP, Toma E, Krebs VLJ, Kimura AF. Breast milk and glucose for pain relief in preterm infants: a noninferiority randomized controlled trial. Pediatrics 2012; 129:664-70. [PMID: 22392169 DOI: 10.1542/peds.2011-2024] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The study goal was to compare the efficacy of expressed breast milk (EBM) versus 25% glucose on pain responses of late preterm infants during heel lancing. METHODS In a noninferiority randomized controlled trial, a total of 113 newborns were randomized to receive EBM (experimental group [EG]) or 25% glucose (control group [CG]) before undergoing heel lancing. The primary outcome was pain intensity (Premature Infant Pain Profile [PIPP]) and a 10% noninferiority margin was established. Secondary outcomes were incidence of cry and percentage of time spent crying and adverse events. Intention-to-treat (ITT) analysis was used. RESULTS Groups were similar regarding demographics and clinical characteristics, except for birth weight and weight at data collection day. There were lower pain scores in the CG over 3 minutes after lancing (P < .001). A higher number of infants in the CG had PIPP scores indicative of minimal pain or absence of pain (P = .002 and P = .003 on ITT analysis) at 30 seconds after lancing, and the mean difference in PIPP scores was 3 (95% confidence interval: 1.507-4.483). Lower incidence of cry (P = .001) and shorter duration of crying (P = .014) were observed for CG. Adverse events were benign and self-limited, and there was no significant difference between groups (P = .736 and P = .637 on ITT analysis). CONCLUSIONS Results based on PIPP scores and crying time indicate poorer effects of EBM compared with 25% glucose during heel lancing. Additional studies exploring the vol and administration of EBM and its combination with other strategies such as skin-to-skin contact and sucking are necessary.
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Affiliation(s)
- Mariana Bueno
- Department of Maternal-Child and Psychiatric Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil.
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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
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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.
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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
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Abstract
BACKGROUND Achievement of adequate oral nutrition is a challenging task after early neonatal cardiac surgery. This study aims to describe predictors of oral feeding outcomes for neonates after early surgical interventions. MATERIALS AND METHODS A retrospective review of neonates admitted with congenital cardiac disease over a period of 1 year. We analysed predictors of the need for a feeding tube at discharge and the amount taken at each feeding. Multilevel modelling was used to look at individual change over time predicting oral amount at each feeding. RESULTS We identified 56 neonates. Diagnoses were heterogeneous; 23% of the infants had associated genetic syndromes and 45% required pre-operative mechanical ventilation. The median time from birth to surgery was 8.4 days, with 29 infants fed orally before surgery. The mean time from surgery to first oral feeding attempt was 12 hours. Time from surgery to oral feeding, the amount taken with first feeding, and cross-clamp times were significant predictors of oral feeding success, whereas the presence of a comorbidity--genetic abnormality--and longer ventilator dependency predicted failure. Almost half of the neonates required a feeding tube upon discharge, and no infant discharged was solely breastfed. Discharge with a feeding tube was associated with greater weight gain at that time. CONCLUSIONS Neonates with congenital cardiac disease face significant barriers to successfully achieving oral feeding on hospital discharge. Enteral feeding guidelines focus on physiological stabilisation and do not always address the developmental milestones necessary to support oral feeding. Future prospective studies are necessary to identify multimodal strategies to optimise early feeding.
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Cheng YW, Kaimal AJ, Bruckner TA, Halloran DR, Hallaron DR, Caughey AB. Perinatal morbidity associated with late preterm deliveries compared with deliveries between 37 and 40 weeks of gestation. BJOG 2011; 118:1446-54. [PMID: 21883872 PMCID: PMC3403292 DOI: 10.1111/j.1471-0528.2011.03045.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To estimate the risk of short-term complications in neonates born between 34 and 36 weeks of gestation. DESIGN This is a retrospective cohort study. SETTING Deliveries in 2005 in the USA. POPULATION Singleton live births between 34 and 40 weeks of gestation. METHODS Gestational age was subgrouped into 34, 35, 36 and 37-40 completed weeks of gestation. Statistical comparisons were performed using chi-square test and multivariable logistic regression models, with 37-40 weeks of gestation designated as referent. MAIN OUTCOME MEASURES Perinatal morbidities, including 5-minute Apgar scores, hyaline membrane disease, neonatal sepsis/antibiotics use, and admission to the intensive care unit. RESULTS In all, 175,112 neonates were born between 34 and 36 weeks in 2005. Compared with neonates born between 37 and 40 weeks, neonates born at 34 weeks had higher odds of 5-minute Apgar <7 (adjusted odds ratio [aOR] 5.51, 95% CI 5.16-5.88), hyaline membrane disease (aOR 10.2, 95% CI 9.44-10.9), mechanical ventilation use >6 hours (aOR 9.78, 95% CI 8.99-10.6) and antibiotic use (aOR 9.00, 95% CI 8.43-9.60). Neonates born at 35 weeks were similarly at risk of morbidity, with higher odds of 5-minute Apgar <7 (aOR 3.42, 95% CI 3.23-3.63), surfactant use (aOR 3.74, 95% CI 3.21-4.22), ventilation use >6 hours (aOR 5.53, 95% CI 5.11-5.99) and neonatal intensive-care unit admission (aOR 11.3, 95% CI 11.0-11.7). Neonates born at 36 weeks remain at higher risk of morbidity compared with deliveries at 37-40 weeks of gestation. CONCLUSIONS Although the risk of undesirable neonatal outcomes decreases with increasing gestational age, the risk of neonatal complications in late preterm births remains higher compared with infants delivered at 37-40 weeks of gestation.
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Affiliation(s)
- Y W Cheng
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 94143-0132, USA.
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Calling S, Li X, Sundquist J, Sundquist K. Socioeconomic inequalities and infant mortality of 46,470 preterm infants born in Sweden between 1992 and 2006. Paediatr Perinat Epidemiol 2011; 25:357-65. [PMID: 21649678 DOI: 10.1111/j.1365-3016.2011.01200.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Studies on possible sociodemographic inequities in the survival of preterm infants are scarce. Individual and neighbourhood sociodemographic factors are related to preterm birth and to infant mortality in full-term infants. The aim here was to examine whether infant mortality in Swedish preterm infants is related to individual and neighbourhood sociodemographic factors, and to study whether the hypothesised association between neighbourhood deprivation and infant mortality persists after accounting for individual sociodemographic factors. The study included 46,470 infants with a gestational length of <37 weeks, born in Sweden between 1992 and 2006. Neighbourhood deprivation was assessed by an index (education, income, unemployment, welfare assistance) in small geographical units, and categorised into low, moderate and high deprivation. Adjusted odds ratios for infant mortality were examined in relation to individual and neighbourhood sociodemographic factors. After adjusting for maternal age, infant mortality was associated with the following sociodemographic variables: maternal non-married/non-cohabiting status, low family income, low maternal education and rural status. After full adjustment, the odds ratio [95% confidence interval] was 2.98 [2.42, 3.67] for low family income compared with high family income. An increase in infant mortality was also associated with high neighbourhood deprivation; however, this increased risk no longer remained statistically significant after adjusting for individual sociodemographic factors. In conclusion, this study showed an increased infant mortality in preterm infants born to women with a less favourable sociodemographic profile.
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Affiliation(s)
- Susanna Calling
- Center for Primary Health Care Research, Lund University, Malmö, Sweden.
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Abstract
Advanced practice nurses, including midwives, are well positioned to conduct, participate, or both in both basic and translational research to improve the outcomes and processes of perinatal care. This article contains suggestions for future research by perinatal advanced practice nurses, conceptualized around a scale to promote balance in outcomes. More research is needed in a number of areas, examples include collaborative practice, normal birth, and translation of the evidence concerning skin-to-skin practice. Health disparities; maternal, neonatal, and infant morbidity and mortality; formula feeding; and other vulnerabilities need more research to decrease these problematic outcomes. Advanced practice nurses are encouraged to be actively involved in perinatal research, to help confront and reduce health disparities, and to apply evidence in practice, broadly promoting wellness for women and their families.
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Souto A, Pudel M, Hallas D. Evidence-based care management of the late preterm infant. J Pediatr Health Care 2011; 25:44-9. [PMID: 21147407 DOI: 10.1016/j.pedhc.2010.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 03/01/2010] [Accepted: 04/07/2010] [Indexed: 10/19/2022]
Affiliation(s)
- Ana Souto
- New York University College of Nursing, New York, NY, USA
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Loring CF, Reilly JE, Gregory K, Gargan B, LeBlanc V, Lundgren D, Walker K, Zaya C. Temperature Control in the Late Preterm Infant: A Comparison of Thermoregulation Following Two Bathing Techniques. J Obstet Gynecol Neonatal Nurs 2010. [DOI: 10.1111/j.1552-6909.2010.01124.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lanari M, Silvestri M, Rossi GA. Palivizumab prophylaxis in ‘late preterm’ newborns. J Matern Fetal Neonatal Med 2010; 23 Suppl 3:53-5. [DOI: 10.3109/14767058.2010.506757] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kirby RS, Wingate MS. Late preterm birth and neonatal outcome: is 37 weeks' gestation a threshold level or a road marker on the highway of perinatal risk? Birth 2010; 37:169-71. [PMID: 20557541 DOI: 10.1111/j.1523-536x.2010.00399.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Russell S Kirby
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida 33612, USA.
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De Matteo R, Blasch N, Stokes V, Davis P, Harding R. Induced preterm birth in sheep: a suitable model for studying the developmental effects of moderately preterm birth. Reprod Sci 2010; 17:724-33. [PMID: 20445008 DOI: 10.1177/1933719110369182] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Our aim was to characterize an ovine model of preterm birth that allows analysis of the developmental effects of preterm birth in the absence of postnatal confounding factors. Preterm birth was induced at 131 days of gestation in 82 lambs; controls (n = 31) were born at term (145 days). Overall survival of preterm lambs was 60%; males had significantly lower survival than females (44% vs 76%); 94% of term lambs survived. Although the birth weight of preterm lambs was approximately 0.9 kg lower than in term lambs, the crown-to-rump and forelimb lengths were similar. At 9 weeks after term-equivalent age, there were no differences in body weight or dimensions between preterm and term lambs; when adjusted for body weight, the heart was 21% heavier in preterm than term lambs. We conclude that moderately preterm birth in sheep is characterized by a greater survival of female lambs than males and has significant effects on organ development.
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Affiliation(s)
- Robert De Matteo
- Department of Anatomy & Developmental Biology, Monash University, Clayton, VIC 3800, Australia.
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Gouyon JB, Vintejoux A, Sagot P, Burguet A, Quantin C, Ferdynus C. Neonatal outcome associated with singleton birth at 34-41 weeks of gestation. Int J Epidemiol 2010; 39:769-76. [DOI: 10.1093/ije/dyq037] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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