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Ito M, Kato S, Saito M, Miyahara N, Arai H, Namba F, Ota E, Nakanishi H. Bronchopulmonary Dysplasia in Extremely Premature Infants: A Scoping Review for Identifying Risk Factors. Biomedicines 2023; 11:biomedicines11020553. [PMID: 36831089 PMCID: PMC9953397 DOI: 10.3390/biomedicines11020553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Over the years, bronchopulmonary dysplasia (BPD) affects the pulmonary function of infants, resulting in chronic health burdens for infants and their families. The aim of this scoping review was to screen available evidence regarding perinatal risk factors associated with the development and severity of BPD. METHODS The eligibility criteria of the studies were year of publication between 2016 and 2021; setting of a developed country; English or Japanese as the study language; and randomized controlled, cohort, or case-control design. The titles and abstracts of the studies were screened by independent reviewers. RESULTS Of 8189 eligible studies, 3 were included for severe BPD and 26 were included for moderate BPD. The risk factors for severe BPD were male sex, iatrogenic preterm birth, maternal hypertensive disorders of pregnancy (HDP), low gestational age, small-for-gestational-age (SGA) birth weight, mechanical ventilation on day 1, and need for patent ductus arteriosus (PDA) management. The risk factors for moderate or severe BPD included male sex, premature rupture of membranes, clinical chorioamnionitis, maternal HDP, SGA birth weight, bubbly/cystic appearance on X-ray, and PDA management. CONCLUSIONS We identified several risk factors for BPD. We plan to confirm the validity of the new classification using the existing dataset.
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Affiliation(s)
- Masato Ito
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita 010-8543, Japan
- Correspondence:
| | - Shin Kato
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8602, Japan
| | - Makoto Saito
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8546, Japan
| | - Naoyuki Miyahara
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe 350-8550, Japan
| | - Hirokazu Arai
- Department of Neonatology, Akita Red Cross Hospital, Akita 010-1495, Japan
| | - Fumihiko Namba
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe 350-8550, Japan
| | - Erika Ota
- Global Health Nursing, Graduate School of Nursing Sciences, St. Luke’s International University, Chuo 104-0044, Japan
- Tokyo Foundation for Policy Research, Tokyo 106-6234, Japan
| | - Hidehiko Nakanishi
- Research and Development Center for New Medical Frontiers, Department of Advanced Medicine, Division of Neonatal Intensive Care Medicine, Kitasato University School of Medicine, Sagamihara 252-0375, Japan
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Enyew EF, Bitew DA, Gelagay AA. Incidence, time to recovery and predictors among neonates admitted with respiratory distress to the neonatal intensive care unit at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2021. PLoS One 2022; 17:e0278887. [PMID: 36520783 PMCID: PMC9754192 DOI: 10.1371/journal.pone.0278887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 11/27/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND One of the major factors contributing to newborn morbidity and mortality across the globe is respiratory distress. In resource-constrained developing nations like Ethiopia, it is a significant issue. Depending on the quality of the care provided, the incidence and time to recovery may differ amongst medical facilities. However, Ethiopia still lacks appropriate data on the incidence and time to recovery from respiratory distress. OBJECTIVE The aim of the study was to assess the incidence, time to recovery, and predictors among neonates admitted with respiratory distress in the neonatal intensive care unit at the University of Gondar Comprehensive Specialized Hospital. METHODS An institution-based retrospective follow-up study design was conducted among 452 neonates with respiratory distress. Data were collected using a data extraction checklist from the medical registry. The extracted data were entered into EPI INFO version 7.2.1.0 and then exported to STATA version 14 for analysis. The median time to recovery, the Kaplan Meier curve, and the log-rank test was computed. Both bi-variable and multivariable Cox regression models were applied to analyze the data. p-value ≤ 0.05 was considered statistically significant. RESULTS Of all respiratory distressed neonate,311 were recovered. The overall incidence rate of neonates admitted with from respiratory distress was 11.5 per 100-neonate day (95% CI: 10.30-12. 87) with 2,703-person day observation and the median time to recovery from respiratory distress was 7 days with (IQR = 3-13 days). Predictors of time to recovery from respiratory distress were very low birth weight (AHR = 0.17, 95% CI: 0.08-0.41), low birth weight (AHR = 0.50, 95% CI: 0.31-0.81), very preterm (AHR = 0.42,95% CI:0.20-0.89), sepsis (AHR = 0.50 95% CI: 0.38-0.65), hypothermia (AHR = 0.61, 95% CI: 0.39-0.81), and Apgar scores less than seven at first (AHR = 0.35, 95% CI: 0.15-0.79) and fifth minute (AHR = 0.45, 95% CI: 0.20-0.97). CONCLUSION The incidence and time to recovery in this study were discreetly acceptable as compared to previous study. The aforementioned predictors could be used to identify neonates with respiratory distress who are at risk of developing a long-term illness and guide prompt referral to hospitals. This will also provide clinicians with prognostic information, as longer recovery times have economic and social implications in resource limited countries like Ethiopia.
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Affiliation(s)
- Engidaw Fentahun Enyew
- Department of Anatomy, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Desalegn Anmut Bitew
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Abebaw Addis Gelagay
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Fneish A, Alhasoon M, Al Essa A, Mahlangu R, Alshami N, Alsaif S, Ali K. Admission temperature and neonatal outcomes - single-centre experience in Saudi Arabia. Int J Pediatr Adolesc Med 2022; 9:203-208. [PMID: 36937323 PMCID: PMC10019951 DOI: 10.1016/j.ijpam.2022.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/03/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
Objective This study aimed to investigate the association between admission hypothermia (AH), neonatal mortality and major neonatal morbidities in preterm infants <33 weeks' gestation. An additional aim of the study was to examine changes in the prevalence of admission hypothermia after the initiation of a thermoregulation quality improvement (QI) project. Method This is a retrospective cohort study of preterm infants < 33 weeks' gestation born at King AbdulAziz Medical City Riyadh (KAMC-R) between January 2017 to December 2020. Results Eight-hundred infants were born during the study period. Four hundred and one infants (50.1%) had an admission temperature of <36.5 °C and a further 399 (49.9%) had an admission temperature of >36.5 °C. The mortality before discharge was 15.7% in infants with AH compared to 4.8% among those with an admission temperature above 36.5 °C. This remained statistically significant after adjustments for gestational age and maternal PET status on a multivariate analysis (P = .001, OR 2.7,95%CI 1.5-4.7). The need for mechanical ventilation (P = .005) and incidence of surgical NEC (P = .030) were significantly different between the two temperature groups. Mean (SD) admission temperature increased from 36.3 °C to 36.6 °C following the thermoregulation intervention program (P <.001). Admission temperature <36 °C is associated with higher mortality in the first week (P = .001, OR 3.3,95% CI (1.7-6.6)) and increased incidence of cystic PVL (P = .04, OR 2.1, CI (1.03-4.3)). Conclusion Preterm infants with AH suffered higher mortality and greater neonatal morbidities.
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Affiliation(s)
- Ammar Fneish
- Neonatal Intensive Care Department, King Abdulaziz Medical City-Riyadh, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Mohammad Alhasoon
- Department of Pediatrics, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia
| | - Amenah Al Essa
- Neonatal Intensive Care Department, King Abdulaziz Medical City-Riyadh, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Radha Mahlangu
- Neonatal Intensive Care Department, King Abdulaziz Medical City-Riyadh, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Noura Alshami
- Neonatal Intensive Care Department, King Abdulaziz Medical City-Riyadh, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Saif Alsaif
- Neonatal Intensive Care Department, King Abdulaziz Medical City-Riyadh, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Kamal Ali
- Neonatal Intensive Care Department, King Abdulaziz Medical City-Riyadh, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- Corresponding author.
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Balazs G, Balajthy A, Riszter M, Kovacs T, Szabo T, Belteki G, Balla G. Incidence, predictors of success and outcome of LISA in very preterm infants. Pediatr Pulmonol 2022; 57:1751-1759. [PMID: 34931458 PMCID: PMC9325361 DOI: 10.1002/ppul.25798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/07/2021] [Accepted: 12/18/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The aim of this study was to examine the success rate of less invasive surfactant administration (LISA), to identify early predictive factors for the outcome of LISA, and to compare neonatal outcomes between the LISA failure group and the group of infants who were successfully treated with LISA. DESIGN A retrospective cohort study. PATIENTS Infants born at less than 33 weeks of gestation (n = 158) and treated with LISA for respiratory distress syndrome. RESULTS LISA was successful in 86 cases (54.4%); 72 preterm infants (45.6%) needed additional surfactant therapy and/or mechanical ventilation in the first 72 h (LISA failure). In a multivariate logistic regression analysis, six independent predictors of LISA success were identified: core temperature at the time of admission (adjusted odds ratio (OR): 3.56), dose of poractant alfa (<200 mg/kg; adjusted OR: 0.254), elevated C-reactive protein (>10 mg/L) at 24 h of life (adjusted OR: 0.28), highest respiratory severity score (RSS) during the first hour of life or at the time of LISA (adjusted OR: 0.463), maternal age (adjusted OR: 0.923), and birth weight (adjusted OR: 1.003). The receiver operating curve created by using the identified factors indicates good predictive power with an area under the curve of 0.85. LISA failure was associated with a substantially higher risk of complications. CONCLUSION LISA success can be predicted by variables available before the intervention. Failure of LISA is relatively frequent event in very preterm infants and is associated with adverse outcomes. Prevention of hypothermia during early stabilization and appropriate dosing of surfactant may increase LISA success rates and improve patient outcome.
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Affiliation(s)
- Gergely Balazs
- Department of Pediatrics, Divison of Neonatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Andras Balajthy
- Department of Pediatrics, Divison of Neonatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Magdolna Riszter
- Department of Pediatrics, Divison of Neonatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tamas Kovacs
- Department of Pediatrics, Divison of Neonatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tamas Szabo
- Department of Pediatrics, Divison of Neonatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gusztav Belteki
- Neonatal Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gyorgy Balla
- Department of Pediatrics, Divison of Neonatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Patel M, Ramagaga N, Kruger D, Lehnerdt G, Mansoor I, Mohlala L, Rendel D, Zaheed F, Jordaan M, Mokhachane M, Nakwa FL, Mphahlele R. Hypothermia in neonates born by caesarean section at a tertiary hospital in South Africa. Front Pediatr 2022; 10:957298. [PMID: 36561484 PMCID: PMC9763723 DOI: 10.3389/fped.2022.957298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION neonatal hypothermia has previously been noted in a large proportion of neonates born through Caesarean section at Chris Hani Baragwanath Hospital (CHBAH), yet no study in South Africa specifically explores the extent and severity of the threat of hypothermia to this population of neonates. OBJECTIVES to describe the proportion and severity of neonatal hypothermia in infants born via Caesarean section at CHBAH as well as to document and describe possible contributing factors to neonatal hypothermia in this population. METHODS A neonatal unit's database records were reviewed for demographic information of patients and their mothers, clinical characteristics, body temperature and outcomes. Comparisons between normothermic and hypothermic neonates were performed. RESULTS Forty-one percent of neonates born via Caesarean section had hypothermia at birth, of whom 71%, 27% and 2% had mild, moderate and severe hypothermia, respectively. Prevalence of admission hypothermia was 42%. On average, neonates were born at term and were of normal birth weight. No maternal factors were found to be statistically significant. Bag-mask ventilation (BMV) and cardiopulmonary resuscitation (CPR) [3.4% vs. 0.7%, p-0.033; OR 2.67 (95% CI: 1.06-6.77)] and an elevated lactate [13.25 vs. 3.2 mmol/l, p-0.032; OR 1.13 (95% CI: 1.01-1.26)] were associated with hypothermia. In the multivariable logistic regression analysis hypothermia in neonates was associated with an elevated lactate. CONCLUSIONS Prevalence of hypothermia in neonates born by Caesarean section is high and further prospective studies are required to elucidate the factors contributing to this.
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Affiliation(s)
- Mariambibi Patel
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Neo Ramagaga
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Danielle Kruger
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Grace Lehnerdt
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Imraan Mansoor
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Lesedi Mohlala
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Dylan Rendel
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Fathima Zaheed
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Mimie Jordaan
- District Clinical Specialist Team, Johannesburg Health District, Johannesburg, South Africa
| | - Mantoa Mokhachane
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Firdose Lambey Nakwa
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa.,Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Ramatsimele Mphahlele
- District Clinical Specialist Team, Johannesburg Health District, Johannesburg, South Africa
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Self-reported syndromes of sexually transmitted infections and its associated factors among reproductive (15-49 years) age women in Ethiopia. Heliyon 2021; 7:e07524. [PMID: 34401559 PMCID: PMC8353284 DOI: 10.1016/j.heliyon.2021.e07524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/05/2021] [Accepted: 07/06/2021] [Indexed: 11/22/2022] Open
Abstract
Background Sexually Transmitted Infections (STIs) are among the most important causes of maternal and neonatal morbidity and mortality. It remains a significant public health problem and disproportionately affects women posing a large public health burden in low and middle-income countries. However, there is little information on the magnitude of self-reported syndromes of STIs among reproductive-age women in Ethiopia. Aim This study aimed to determine the magnitude of self-reported syndromes of sexual transmitted infections and its associated factors among women of reproductive age in Ethiopia. Methods The study was based on the data from the Ethiopian Demographic Health Survey of 2016. The data on the status of self-reported STIs were extracted from the individual women dataset, and a total of 15,683 reproductive-age women were involved in the study. Since the data has a hierarchical and cluster nature sampling weight was applied for all analysis procedures to account for complex survey design. Rao-scot chi-square test that adjusts for complex sample design was used to examine the association of outcome and independent variables. In, multivariable analysis, the level of statistical significance was declared at P-value ≤ 0.05. Findings and conclusions The magnitude of self-reported STIs was 3.0 % (95% CI: 2.92–3.08). Among self-reported syndromes of STIs only, 33.3 % (158) seek care for sexually transmitted infections. Age (Adjusted Odds Ratio (AOR = 2.15; 95%CI:1.4, 3.4)), marital status (AOR = 1.72; 95%CI:1.02, 2.90), women attending higher education and above (AOR = 2.67; 95%CI:1.57,4.57), history of termination of pregnancy (AOR = 2.85; 95%CI:2.0,4.08), and risky sexual behavior (AOR = 1.72; 95%CI:1.02,2.90) were found to be associated with self-reported syndrome of sexually transmitted infections. The magnitude of self-reported syndromes of STI and health care seeking behaviors among reproductive-age women was found low. Therefore, the government should enhance the awareness of women for sexually transmitted syndromes, and increase accessibility of STI services. Moreover, qualitative studies should be done to identify the demand, supply, and barriers related to STI among women of reproductive age women in Ethiopia.
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Ralphe JL, Silva SG, Dail RB, Brandon DH. Body temperature instability and respiratory morbidity in the very low birth weight infant: a multiple case, intensive longitudinal study. BMC Pediatr 2020; 20:485. [PMID: 33081746 PMCID: PMC7574536 DOI: 10.1186/s12887-020-02351-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/15/2020] [Indexed: 12/23/2022] Open
Abstract
Background Very low birth weight (VLBW) infant thermal instability upon neonatal intensive care unit admission has been associated with respiratory morbidity; however, the association between ongoing thermal instability and respiratory morbidity remains unclear. Methods A longitudinal data analysis was conducted on 12 VLBW infants. Chronic respiratory morbidity risk was defined as supplemental oxygen requirement (FiO2) or scheduled diuretic dosing at 36 weeks post-menstrual age. Acute respiratory morbidity was quantified as desaturations (SpO2<90%), bradycardia with desaturations (HR<100 and SpO2<90%), apnea, increase in FiO2 requirement, or increase in respiratory support. Multi-level, mixed-effects models and regression analysis examined the relationships between body temperature over the first 14 days of life and respiratory morbidities. Results Body temperature was not associated with chronic respiratory morbidity risk (p=0.2765). Desaturations, bradycardia with desaturations, increased FiO2 requirement, and increased respiratory support were associated with decreased body temperature (p<0.05). Apnea was associated with increased body temperature (p<0.05). The covariate-adjusted risk of desaturations (aOR=1.3), bradycardia with desaturations (aOR=2.2), increase in FiO2 requirement (aOR=1.2), and increase in respiratory support (aOR=1.2) were significantly greater during episodes of hypothermia. Conclusion VLBW infants are dependent on a neutral thermal environment for optimal growth and development. Therefore, the significant associations between hypothermia and symptoms of acute respiratory morbidity require further study to delineate if these are causal relationships that could be attenuated with clinical practice changes, or if these are concurrent symptoms that cluster during episodes of physiological instability.
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Affiliation(s)
- Jane L Ralphe
- University of Wisconsin-Madison School of Nursing, University of Wisconsin, 701 Highland Ave. Madison, WI, WI 53705, Madison, USA.
| | - Susan G Silva
- Duke University School of Nursing, Duke University, NC, Durham, USA.,Duke University School of Medicine, Duke University, NC, Durham, USA
| | - Robin B Dail
- University of South Carolina College of Nursing, University of South Carolina, SC, Columbia, USA
| | - Debra H Brandon
- Duke University School of Nursing, Duke University, NC, Durham, USA.,Duke University School of Medicine, Duke University, NC, Durham, USA
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Chiu HY, Chu SM, Lin HY, Tsai ML, Chen YT, Lin HC. Evidence base multi-discipline critical strategies toward better tomorrow for very preterm infants. Pediatr Neonatol 2020; 61:371-377. [PMID: 32201157 DOI: 10.1016/j.pedneo.2020.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/30/2019] [Accepted: 01/21/2020] [Indexed: 12/15/2022] Open
Abstract
Despite advances in neonatal intensive care in the recent decade, a large number of very preterm infants (VPIs) remain at risk for significant neurodevelopmental impairment (NDI). Given that there are many interventions need to be implemented during the critical perinatal period so that complications of these vulnerable VPIs could be minimized, it is urgent to develop multi-discipline strategies based on evidence to be carried out. The objective of this new term evidence-based perinatal critical strategies (EBPCS), is to provide beneficial intervention towards better neurodevelopmental outcomes, specifically for preterm infants below 28 weeks gestational age. EBPCS is defined as the management of the VPIs during the perinatal period which would include antenatal counseling with team briefing and share decision making, treat the chorioamnionitis, antenatal MgS04, antenatal steroid, delayed cord clamping/milking, neonatal resuscitation team preparation, prevention of hypothermia, immediate respiratory support with continuous positive airway pressure at delivery room, less invasive surfactant administration, early surfactant with budesonide therapy, support of cardiovascular system, early initiate of probiotics administration, early caffeine, early parenteral and enteral nutrition, promptly initiating antibiotics. These critical strategies will be discussed detail in the text; nonetheless, standardized protocols, technical skills and repeated training are the cornerstones of successful of EBPCS. Further experience from different NICU is needed to prove whether these very complicate and comprehensive perinatal critical strategies could translate into daily practice to mitigate the incidence of NDI in high-risk VPIs.
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Affiliation(s)
- Hsiao-Yu Chiu
- Department of Neonatology, China Medical University Children's Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
| | - Shih-Ming Chu
- Division of Neonatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Hsiang-Yu Lin
- Department of Neonatology, China Medical University Children's Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
| | - Ming-Luen Tsai
- Department of Neonatology, China Medical University Children's Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
| | - Yin-Ting Chen
- Department of Neonatology, China Medical University Children's Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Hung-Chih Lin
- Department of Neonatology, China Medical University Children's Hospital, Taichung, Taiwan; School of Chinese Medicine, China Medical University, Taichung, Taiwan; Asia University Hospital, Asia University, Taichung, Taiwan.
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9
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Phoya F, Langton J, Dube Q, Iroh Tam PY. Association of Neonatal Hypothermia with Morbidity and Mortality in a Tertiary Hospital in Malawi. J Trop Pediatr 2020; 66:470-478. [PMID: 32176776 PMCID: PMC7532991 DOI: 10.1093/tropej/fmz086] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate associations with neonatal hypothermia in a tertiary-level neonatal unit (NU) in Malawi. METHODS Neonates with a birth weight >1000 g were recruited and temperatures were recorded 5 min after birth, on admission and 4 h thereafter. Clinical course and outcome were reviewed. Data were analysed using Stata v.15 and p < 0.05 was considered statistically significant. RESULTS Between August 2018 to March 2019, 120 neonates were enrolled, and 112 were included in the data analysis. Hypothermia at 5 min after birth was noted in 74%, 77% on admission to the NU and 38% at 24 h. Neonates who had hypothermia 5 min after birth were more likely to have hypothermia on admission to the NU compared with normothermic subjects (p < 0.01). All neonates with hypothermia on admission to the NU died (100 vs.72%, p = 0.02), but hypothermia at 5 min nor at 24 h were not associated with mortality. After adjusting for potential confounders, the odds ratio of hypothermia at 5 min for hypothermia on admission to NU was 13.31 (95% CI 4.17-42.54). DISCUSSION A large proportion of hospitalized neonates is hypothermic on admission and has associated morbidity and mortality. Our findings suggest that a strong predictor of mortality is neonatal hypothermia on admission to the NU, and that early intervention in the immediate period after delivery could decrease the incidence of hypothermia and reduce associated morbidity and mortality.
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Affiliation(s)
- Frank Phoya
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi,Department of Paediatrics, University of Malawi College of Medicine, Blantyre, Malawi
| | - Josephine Langton
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi,Department of Paediatrics, University of Malawi College of Medicine, Blantyre, Malawi
| | - Queen Dube
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi,Department of Paediatrics, University of Malawi College of Medicine, Blantyre, Malawi
| | - Pui-Ying Iroh Tam
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi,Department of Paediatrics, University of Malawi College of Medicine, Blantyre, Malawi,Paediatrics and Child Health Research Group, Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK,Correspondence: Pui-Ying Iroh Tam, Malawi-Liverpool Wellcome Trust Clinical Research Programme, P. O. Box 30096, Chichiri, Blantyre, Malawi. E-mail <>
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10
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de Siqueira Caldas JP, Ferri WAG, Marba STM, Aragon DC, Guinsburg R, de Almeida MFB, Diniz EMA, Silveira RCS, Alves Junior JMS, Pavanelli MB, Bentlin MR, Ferreira DMLM, Vale MS, Fiori HH, Duarte JLMB, Meneses JA, Cwajg S, Carvalho WB, Ferrari LSL, Silva NMM, da Silva RPGVC, Anchieta LM, Santos JPF, Kawakami MD. Admission hypothermia, neonatal morbidity, and mortality: evaluation of a multicenter cohort of very low birth weight preterm infants according to relative performance of the center. Eur J Pediatr 2019; 178:1023-1032. [PMID: 31056716 DOI: 10.1007/s00431-019-03386-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 04/08/2019] [Accepted: 04/16/2019] [Indexed: 11/29/2022]
Abstract
This prospective cohort study aimed to assess the association of admission hypothermia (AH) with death and/or major neonatal morbidities among very low birth weight (VLBW) preterm infants based on the relative performance of 20 centers of the Brazilian Network of Neonatal Research. This is a retrospective analysis of prospectively collected data using the database registry of the Brazilian Network on Neonatal Research. Center performance was defined by the relative mortality rate using conditional inference trees. A total of 4356 inborn singleton VLBW preterm infants born between January 2013 and December 2016 without malformations were included in this study. The centers were divided into two groups: G1 (with lower mortality rate) and G2 (with higher mortality rate). Crude and adjusted relative risks (RR) and 95% confidence intervals (95%CI) were estimated by simple and multiple log-binomial regression models. An AH rate of 53.7% (19.8-93.3%) was significantly associated with early neonatal death in G1 (adjusted RR 1.41, 95% CI 1.09-1.84) and G2 (adjusted RR 1.29, 95%CI 1.01-1.65) and with in-hospital death in G1 (adjusted RR 1.29, 95%CI 1.07-1.58). AH was significantly associated with a lower frequency of necrotizing enterocolitis (adjusted RR 0.58, 95%CI 38-0.88) in G2.Conclusion: AH significantly associated with early neonatal death regardless of the hospital performance. In G2, an unexpected protective association between AH and necrotizing enterocolitis was found, whereas the other morbidities assessed were not significantly associated with AH. What is Known: • Admission hypothermia is associated with early neonatal death. • The association of admission hypothermia with major neonatal morbidities has not been fully established. What is New: • Admission hypothermia was significantly associated with early neonatal and in-hospital death in centers with the lowest relative mortality rates. • Admission hypothermia was not associated with major neonatal morbidities and with in-hospital death but was found to be a protective factor against necrotizing colitis in centers with the highest relative mortality rates.
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Affiliation(s)
- Jamil Pedro de Siqueira Caldas
- Department of Pediatrics, Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, Brazil. .,, Campinas, Brazil.
| | - Walusa A G Ferri
- Department of Pediatrics, Faculdade de Medicina de Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Sérgio T M Marba
- Department of Pediatrics, Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, Brazil.,, São Paulo, Brazil
| | - Davi C Aragon
- Department of Pediatrics, Faculdade de Medicina de Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Ruth Guinsburg
- , São Paulo, Brazil.,Division of Neonatal Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Maria F B de Almeida
- , São Paulo, Brazil.,Division of Neonatal Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Edna M A Diniz
- Department of Pediatrics, University of São Paulo, School of Medicine, São Paulo, Brazil.,Instituto da Criança, Av Dr. Enéas de Carvalho Aguiar, 647, Pinheiros, São Paulo, São Paulo, 05403-000, Brazil
| | - Rita C S Silveira
- Division of Neonatology, Universidade Federal do Rio Grande do Sul/Hospital de Clínicas de Porto Alegre -HCPA, Rua Silva Jardim 1155/701, Porto Alegre, Rio Grande do Sul, 90450071, Brazil
| | - José M S Alves Junior
- Department of Pediatrics, Maternidade Hilda Brandão - Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil.,, Belo Horizonte, Brazil
| | - Marco B Pavanelli
- , São Paulo, Brazil.,Neonatal Unit, Hospital Geral de Pirajussara, Taboão da Serra, Brazil
| | - Maria R Bentlin
- , São Paulo, Brazil.,Division of Neonatology, Faculdade de Medicina de Botucatu da, Universidade Estadual Paulista, Botucatu, Brazil
| | - Daniela M L M Ferreira
- Department of Pediatrics, Universidade Federal de Uberlândia, Uberlândia, Brazil.,, Uberlândia, Brazil
| | - Marynéa S Vale
- Department of Pediatrics, Universidade Federal do Maranhão, São Luís, Brazil.,, São Luís, Brazil
| | - Humberto H Fiori
- Department of Pediatrics, Hospital São Lucas - Faculdade de Medicina da, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.,, Porto Alegre, Brazil
| | - José L M B Duarte
- Department of Pediatrics, Hospital Universitário Pedro Ernesto - Universidade do Estado de Rio de Janeiro, Rio de Janeiro, Brazil.,, Rio de Janeiro, Brazil
| | - Jucille A Meneses
- Department of Pediatrics, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil.,, Recife, Brazil
| | - Silvia Cwajg
- , Rio de Janeiro, Brazil.,Division of Neonatology, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Werther B Carvalho
- Department of Pediatrics, University of São Paulo, School of Medicine, São Paulo, Brazil.,Instituto da Criança, Av Dr. Enéas de Carvalho Aguiar, 647, Pinheiros, São Paulo, São Paulo, 05403-000, Brazil
| | - Lígia S L Ferrari
- Department of Pediatrics, Hospital Universitário - Universidade Estadual de Londrina, Curitiba, Brazil.,, Londrina, Brazil
| | - Nathalia M M Silva
- Neonatal Unit, Hospital Estadual de Diadema, Diadema, Brazil.,, Diadema, Brazil
| | - Regina P G V C da Silva
- Department of Pediatrics, Hospital de Clínicas - Universidade Federal do Paraná, Curitiba, Brazil.,, Curitiba, Brazil
| | - Leni M Anchieta
- Division of Neonatology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,, Belo Horizonte, Brazil
| | - Juliana P F Santos
- Neonatal Division, Hospital Estadual Sumaré, Sumaré, Brazil.,, Sumaré, Brazil
| | - Mandira D Kawakami
- Division of Neonatal Medicine, Federal University of São Paulo, São Paulo, Brazil.,, Atibaia, Brazil
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11
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Elbaum C, Beam KS, Dammann O, Dammann CEL. Antecedents and outcomes of hypothermia at admission to the neonatal intensive care unit. J Matern Fetal Neonatal Med 2019; 34:66-71. [PMID: 30885030 DOI: 10.1080/14767058.2019.1597043] [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: 10/27/2022]
Abstract
Objective: To evaluate the association between morbidities preceding and following neonatal intensive care unit (NICU) admission with hypothermia.Study design: NICU admission temperatures for 1271 infants admitted to the NICU at Tufts Medical Center (TMC) between 2012 and 2015 were compared to all Vermont Oxford Network (VON) centers in 2014. We analyzed demographic data, prevalence of hypothermia, and associations with prenatal and neonatal morbidities.Result: Prevalence of hypothermia at TMC was 19% compared to 25% in the VON. We found a significant association between hypothermia and maternal race, birth weight, gestational age, antenatal steroids, chorioamnionitis, mode of delivery, and Apgar scores.Conclusion: Continued emphasis should be placed on avoiding neonatal hypothermia during the first hours of postnatal life.
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Affiliation(s)
| | - Kristyn S Beam
- Division of Newborn Medicine, Department of Pediatrics, Floating Hospital for Children at Tufts Medical Center, Boston, MA, USA
| | - Olaf Dammann
- Tufts University School of Medicine, Boston, MA, USA.,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.,Perinatal Neuroepidemiology Unit, Hannover Medical School, Hannover, Germany
| | - Christiane E L Dammann
- Tufts University School of Medicine, Boston, MA, USA.,Division of Newborn Medicine, Department of Pediatrics, Floating Hospital for Children at Tufts Medical Center, Boston, MA, USA
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12
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Jensen CF, Sellmer A, Ebbesen F, Cipliene R, Johansen A, Hansen RM, Nielsen JP, Nikitina OH, Petersen JP, Henriksen TB. Sudden vs Pressure Wean From Nasal Continuous Positive Airway Pressure in Infants Born Before 32 Weeks of Gestation: A Randomized Clinical Trial. JAMA Pediatr 2018; 172:824-831. [PMID: 30039171 PMCID: PMC6143058 DOI: 10.1001/jamapediatrics.2018.2074] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Nasal continuous positive airway pressure (nCPAP) is a well-established treatment of respiratory distress syndrome in preterm infants. Suboptimal weaning from nCPAP may be associated with lung injury, pulmonary morbidity, and infant weight gain. To our knowledge, the best weaning strategy from nCPAP is unknown. OBJECTIVE To compare the effect of sudden wean and pressure wean from nCPAP in very preterm infants. DESIGN, SETTING, AND PARTICIPANTS A randomized, clinical, open-label, multicenter trial was conducted at 6 neonatal intensive care units in Denmark from September 2012 to December 2016 and included infants born before 32 weeks of gestation. INTERVENTIONS Sudden wean with discontinuation of nCPAP without a prior reduction in pressure. Pressure wean with gradual pressure reduction prior to the discontinuation of nCPAP. MAIN OUTCOME AND MEASURES The primary outcome was weight gain velocity from randomization to postmenstrual age 40 weeks. Secondary outcomes included other measures of growth, nCPAP and the duration of oxygen supplementation, postmenstrual age at successful wean and at discharge, successful wean at the first attempt, the number of attempts to wean, and the length of the hospital stay. Prespecified subgroup analyses by gestational age were performed. RESULTS Of the 372 randomized infants, 185 (49.7%) were randomized to sudden wean and 187 infants (50.3%) to pressure wean. A total of 177 infants in both groups completed the trial (median gestational age for sudden and pressure wean, 30 weeks [interquartile range, 29-31]; male: sudden wean, 89 [50%]; pressure wean, 96 [54%]). There was no difference in mean [SD] weight gain velocity from randomization to 40 weeks postmenstrual age between the 2 groups (22 [6] g/kg/day). No difference was found in any of the secondary outcomes. More infants born before 28 weeks of gestation were successfully weaned from nCPAP during the first attempt in the pressure wean group compared with the sudden wean group (risk difference, 31%; 95% CI, 13%-50%), but there was no difference in the duration of nCPAP and oxygen supplementation. CONCLUSIONS AND RELEVANCE Overall, we found no difference in weight gain velocity or any of the secondary outcomes between very preterm infants who were randomized to sudden wean or pressure wean from nCPAP. However, among infants born before 28 weeks' gestation, infants from the pressure wean group were more often successfully weaned during the first attempt without a longer total duration of nCPAP treatment. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01721629.
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Affiliation(s)
- Christina Friis Jensen
- Perinatal Epidemiology Research Unit, Aarhus University Hospital, Aarhus, Denmark,Child and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Anna Sellmer
- Perinatal Epidemiology Research Unit, Aarhus University Hospital, Aarhus, Denmark,Child and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Finn Ebbesen
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Rasa Cipliene
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Anders Johansen
- Department of Pediatrics, Randers Regional Hospital, Randers, Denmark
| | | | | | | | | | - Tine Brink Henriksen
- Perinatal Epidemiology Research Unit, Aarhus University Hospital, Aarhus, Denmark,Child and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
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