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Jain S, Barnes-Davis ME, Fu TT, Sahay RD, Ehrlich SR, Liu C, Kline-Fath B, Habli M, Parikh NA. Hypertensive Disorders of Pregnancy and Risk of Early Brain Abnormalities on Magnetic Resonance Imaging at Term among Infants Born at ≤32 Weeks' Gestational Age. J Pediatr 2024; 273:114133. [PMID: 38838850 DOI: 10.1016/j.jpeds.2024.114133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/23/2024] [Accepted: 05/29/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE To evaluate the proximal effects of hypertensive disorders of pregnancy (HDP) on a validated measure of brain abnormalities in infants born at ≤32 weeks' gestational age (GA) using magnetic resonance imaging at term-equivalent age. STUDY DESIGN In a multisite prospective cohort study, 395 infants born at ≤32 weeks' GA, underwent 3T magnetic resonance imaging scan between 39 and 44 weeks' postmenstrual age. A single neuroradiologist, blinded to clinical history, evaluated the standardized Kidokoro global brain abnormality score as the primary outcome. We classified infants as HDP-exposed by maternal diagnosis of chronic hypertension, gestational hypertension, pre-eclampsia, or eclampsia. Linear regression analysis identified the independent effects of HDP on infant brain abnormalities, adjusting for histologic chorioamnionitis, maternal smoking, antenatal steroids, magnesium sulfate, and infant sex. Mediation analyses quantified the indirect effect of HDP mediated via impaired intrauterine growth and prematurity and remaining direct effects on brain abnormalities. RESULTS A total of 170/395 infants (43%) were HDP-exposed. Adjusted multivariable analyses revealed HDP-exposed infants had 27% (95% CI 5%-53%) higher brain abnormality scores than those without HDP exposure (P = .02), primarily driven by increased white matter injury/abnormality scores (P = .01). Mediation analyses showed HDP-induced impaired intrauterine growth significantly (P = .02) contributed to brain abnormality scores (22% of the total effect). CONCLUSIONS Maternal hypertension independently increased the risk for early brain injury and/or maturational delays in infants born at ≤32 weeks' GA with an indirect effect of 22% resulting from impaired intrauterine growth. Enhanced prevention/treatment of maternal hypertension may mitigate the risk of infant brain abnormalities and potential neurodevelopmental impairments.
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Affiliation(s)
- Shipra Jain
- The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Neurodevelopmental Disorders Prevention Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Maria E Barnes-Davis
- The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Neurodevelopmental Disorders Prevention Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Ting Ting Fu
- The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Rashmi D Sahay
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Shelley R Ehrlich
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Chunyan Liu
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Beth Kline-Fath
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Mounira Habli
- The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, Trihealth Good Samaritan Hospital, Cincinnati, OH
| | - Nehal A Parikh
- The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Neurodevelopmental Disorders Prevention Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
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Kim HR, Lee BK. Outcomes of singleton preterm very low birth weight infants born to mothers with pregnancy-induced hypertension. Sci Rep 2023; 13:6100. [PMID: 37055502 PMCID: PMC10102139 DOI: 10.1038/s41598-023-33206-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/09/2023] [Indexed: 04/15/2023] Open
Abstract
The association between maternal pregnancy-induced hypertension (PIH) and neonatal mortality and morbidities in preterm infants has not been consistent. This study aimed to evaluate the influence of maternal PIH on mortality and morbidities in singleton infants with very low birth weight born before 30 weeks of gestational age using the Korean Neonatal Network (KNN) database. A total of 5340 singleton infants with very low birth weight were registered in the KNN registry, who were born at 23+0 to 29+6 weeks of gestational age between January 2015 and December 2020. Baseline characteristics and neonatal mortality and morbidities were compared between infants with PIH and non-PIH mothers. After adjustment for potential confounders, infants with PIH mothers had significantly higher odds of respiratory distress syndrome (OR 1.983; 95% CI 1.285-3.061, p = 0.002) and bronchopulmonary dysplasia (OR 1.458; 95% CI 1.190-1.785, p < 0.001), and severe bronchopulmonary dysplasia (OR 1.411; 95% CI 1.163-1.713, p < 0.001) than infants with non-PIH mothers, while there were no significant differences in severe intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity, or death during neonatal intensive care unit admission between infants with PIH and non-PIH mothers. This study showed that preterm infants with PIH mothers had an increased risk of neonatal respiratory morbidities, including respiratory distress syndrome and bronchopulmonary dysplasia.
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Affiliation(s)
- Hye-Rim Kim
- Department of Pediatrics, Bundang CHA Medical Center, CHA University, Seongnam, Korea
| | - Byoung Kook Lee
- Department of Pediatrics, Chungnam National University Sejong Hospital, 20, Bodeum 7-ro, Sejong-si, Sejong, Republic of Korea.
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Aynalem YA, Mekonen H, Getaneh K, Yirga T, Chanie ES, Bayih WA, Shiferaw WS. Determinants of neonatal mortality among preterm births in Black Lion Specialized Hospital, Addis Ababa, Ethiopia: a case-cohort study. BMJ Open 2022; 12:e043509. [PMID: 35144942 PMCID: PMC8845183 DOI: 10.1136/bmjopen-2020-043509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 01/07/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Preterm neonatal death is a global burden in both developed and developing countries. In Ethiopia, it is the first and fourth cause of newborn and under-5 deaths, respectively. From 2015 to present, the government of Ethiopia showed its effort to improve the survival of neonates, mainly preterm births, through the inclusion of high-impact life-saving neonatal interventions. Despite these efforts, the cause of preterm neonatal death is still not reduced as expected. Therefore, this study aimed to identify determinants of preterm neonatal mortality. METHODS An institution-based retrospective case-cohort study was conducted among a cohort of preterm neonates who were born between March 2013 and February 2018. A total of 170 cases were considered when the neonates died during the retrospective follow-up period, which was confirmed by reviewing a medical death certificate. Controls were 404 randomly selected charts of neonates who survived the neonatal period. Data were collected from patient charts using a data extraction tool, entered using EpiData V.3.1 and analysed using STATA V.14. Finally, a multivariate logistic regression analysis was performed, and goodness of fit of the final model was tested using the likelihood ratio test. Statistical significance was declared at a p value of ≤0.05. RESULTS In this study, the overall incidence rate of mortality was 39.1 (95% CI: 33.6 to 45.4) per 1000 neonate-days. Maternal diabetes mellitus (adjusted OR (AOR): 2.3 (95% CI: 1.4 to 3.6)), neonatal sepsis (AOR: 1.6 (95% CI: 1.1 to 2.4)), respiratory distress (AOR: 1.5 (95% CI: 1.1 to 2.3)), extreme prematurity (AOR: 2.9 (95% CI: 1.61 to 5.11)), low Apgar score (AOR: 3.1 (95% CI: 1.79 to 5.05)) and premature rupture of membranes (AOR: 2.3 (95% CI: 1.8 to 3.5)) were found to be predictors. CONCLUSION In this study, the overall incidence was found to be high. Premature rupture of membranes, maternal diabetes mellitus, sepsis, respiratory distress, extreme prematurity and low Apgar score were found to be predictors of neonatal mortality. Therefore, it should be better to give special attention to patients with significantly associated factors.
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Affiliation(s)
| | - Hussien Mekonen
- Addis Ababa University, College of Health Sciences, Addis Ababa, Addis Ababa, Ethiopia
| | | | - Tadesse Yirga
- Debre Markos University, Debre Markos, Amhara, Ethiopia
| | - Ermias Sisay Chanie
- Pediatrics and Neonatal Nursing, Debre Tabor University, Debre Tabor, Ethiopia
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van Beek PE, Andriessen P, Onland W, Schuit E. Prognostic Models Predicting Mortality in Preterm Infants: Systematic Review and Meta-analysis. Pediatrics 2021; 147:peds.2020-020461. [PMID: 33879518 DOI: 10.1542/peds.2020-020461] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Prediction models can be a valuable tool in performing risk assessment of mortality in preterm infants. OBJECTIVE Summarizing prognostic models for predicting mortality in very preterm infants and assessing their quality. DATA SOURCES Medline was searched for all articles (up to June 2020). STUDY SELECTION All developed or externally validated prognostic models for mortality prediction in liveborn infants born <32 weeks' gestation and/or <1500 g birth weight were included. DATA EXTRACTION Data were extracted by 2 independent authors. Risk of bias (ROB) and applicability assessment was performed by 2 independent authors using Prediction model Risk of Bias Assessment Tool. RESULTS One hundred forty-two models from 35 studies reporting on model development and 112 models from 33 studies reporting on external validation were included. ROB assessment revealed high ROB in the majority of the models, most often because of inadequate (reporting of) analysis. Internal and external validation was lacking in 41% and 96% of these models. Meta-analyses revealed an average C-statistic of 0.88 (95% confidence interval [CI]: 0.83-0.91) for the Clinical Risk Index for Babies score, 0.87 (95% CI: 0.81-0.92) for the Clinical Risk Index for Babies II score, and 0.86 (95% CI: 0.78-0.92) for the Score for Neonatal Acute Physiology Perinatal Extension II score. LIMITATIONS Occasionally, an external validation study was included, but not the development study, because studies developed in the presurfactant era or general NICU population were excluded. CONCLUSIONS Instead of developing additional mortality prediction models for preterm infants, the emphasis should be shifted toward external validation and consecutive adaption of the existing prediction models.
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Affiliation(s)
- Pauline E van Beek
- Department of Neonatology, Máxima Medical Centre, Veldhoven, Netherlands;
| | - Peter Andriessen
- Department of Neonatology, Máxima Medical Centre, Veldhoven, Netherlands.,Department of Applied Physics, School of Medical Physics and Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Wes Onland
- Department of Neonatology, Amsterdam University Medical Centers and University of Amsterdam, Amsterdam, Netherlands
| | - Ewoud Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands; and.,Cochrane Netherlands, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
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Gupta S, Adhisivam B, Bhat BV, Plakkal N, Amala R. Short Term Outcome and Predictors of Mortality Among Very Low Birth Weight Infants - A Descriptive Study. Indian J Pediatr 2021; 88:351-357. [PMID: 32813195 DOI: 10.1007/s12098-020-03456-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/15/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To assess the short term outcome and predictors of mortality among very low birth weight (VLBW) neonates. METHODS This descriptive study from a tertiary care teaching institute in south India included 239 VLBW neonates who were uniformly managed as per unit's protocol and followed up till discharge or death, whichever was earlier. Univariate analysis and logistic regression analysis were done to determine the predictors of mortality. Two logistic regression models were developed and to evaluate their discriminative performance, area under the receiver operating characteristic curves were calculated. RESULTS Mean gestational age and mean birth weight of neonates were 31.4 ± 3 wk and 1191 ± 245 g respectively. Among the 239 infants, 49 (20.5%) expired and 190 (70.5%) survived. Mortality among extremely low birth weight (ELBW) and extreme preterm infants were 69.3% and 73.3% respectively. Univariate analysis showed multiple perinatal factors and neonatal morbidities were associated with mortality. On adjusted multivariate logistic regression, birth weight < 1000 g (OR 9.27), severe grade of intraventricular hemorrhage (IVH) (OR 29.2), hyperglycemia (OR 7.8) and respiratory distress syndrome (RDS) requiring surfactant therapy (OR 6.2) were the significant predictors of mortality. Both logistic regression models developed showed good prediction of mortality. CONCLUSIONS VLBW mortality rate is 20% in the population studied. Birth weight < 1000 g, severe grade of IVH, hyperglycemia, and RDS requiring surfactant therapy were the significant predictors of mortality among VLBW neonates. Both prediction models developed showed good prediction of mortality.
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Affiliation(s)
- Sushil Gupta
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India
| | - B Adhisivam
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India.
| | - B Vishnu Bhat
- Professor of Pediatrics and Neonatology, AVMC, Pondicherry, India
| | - Nishad Plakkal
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India
| | - R Amala
- Department of Biostatistics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Do preterm girls need different nutrition to preterm boys? Sex-specific nutrition for the preterm infant. Pediatr Res 2021; 89:313-317. [PMID: 33184497 DOI: 10.1038/s41390-020-01252-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 11/09/2022]
Abstract
Boys born preterm are recognised to be at higher risk of adverse outcomes than girls born preterm. Despite advances in neonatal intensive care and overall improvements in neonatal morbidity and mortality, boys born preterm continue to show worse short- and long-term outcomes than girls. Preterm birth presents a nutritional crisis during a critical developmental period, with postnatal undernutrition and growth-faltering common complications of neonatal intensive care. Furthermore, this preterm period corresponds to that of rapid in utero brain growth and development, and the developmental window relating to foetal programming of adult non-communicable diseases, the prevalence of which are associated both with preterm birth and sex. There is increasing evidence to show that from foetal life, boys and girls have different responses to maternal nutrition, that maternal breastmilk composition differs based on foetal sex and that early neonatal nutritional interventions affect boys and girls differently. This narrative review examines the evidence that sex is an important moderator of the outcomes of preterm nutrition intervention, and describes what further knowledge is required before providing nutrition intervention for infants born preterm based on their sex. IMPACT: This review examines the increasing evidence that boys and girls respond differently to nutritional stressors before birth, that maternal breastmilk composition differs by foetal sex and that nutritional interventions have different responses based on infant sex. Boys and girls born preterm are given standard nutritional support which does not take infant sex into account, and few studies of neonatal nutrition consider infant sex as a potential mediator of outcomes. By optimising early nutrition for boys and girls born preterm, we may improve outcomes for both sexes. We propose future studies of neonatal nutritional interventions should consider infant sex.
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Mekasha A, Tazu Z, Muhe L, Abayneh M, Gebreyesus G, Girma A, Berhane M, McClure EM, Goldenberg RL, Nigussie AK. Factors Associated with the Death of Preterm Babies Admitted to Neonatal Intensive Care Units in Ethiopia: A Prospective, Cross-sectional, and Observational Study. Glob Pediatr Health 2020; 7:2333794X20970005. [PMID: 33283024 PMCID: PMC7689001 DOI: 10.1177/2333794x20970005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/05/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022] Open
Abstract
Aim. To determine the risk factors for death among preterm
neonates. Methods and materials. The data set used was derived
from a prospective, multi-center, observational clinical study conducted in 5
tertiary hospitals in Ethiopia from July, 2016 to May, 2018. Subjects were
infants admitted into neonatal intensive care unit. Results.
Risk factors were determined using statistical model developed for this study.
The mean gestational age was 32.87 (SD ± 2.42) weeks with a range of 20 to
36 weeks. There were 2667 (70.69%) survivors and 1106 (29.31%) deaths. The
significant risk factors for preterm death were low gestational age, low birth
weight, being female, feeding problem, no antenatal care visits and vaginal
delivery among mothers with higher educational level.
Conclusions. The study identified several risk factors for
death among preterm neonates. Most of the risk factors are preventable. Thus, it
is important to address neonatal and maternal factors identified in this study
through appropriate ANC and optimum infant medical care and feeding practices to
decrease the high rate of preterm death.
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Affiliation(s)
- Amha Mekasha
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zelalem Tazu
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lulu Muhe
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mahlet Abayneh
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Goitom Gebreyesus
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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A need for an update of Polish birth weight reference norms. ANTHROPOLOGICAL REVIEW 2020. [DOI: 10.2478/anre-2020-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The indicators of perinatal outcome are birth weight and gestational age. The standard method of assessing the outcome is comparing the newborn’s birth weight with the reference system, presented in the form of percentile charts. Acceleration or delay in prenatal development, which are associated with environmental changes, stress the need to validate the developmental norms. The goal of this study is to evaluate the need to construct new and accurate reference standards. The study includes data of newborns from singleton pregnancies: 4919 born in 2000 and 3683 born in 2015. Study variables included gestational age, sex, and birth weight. Percentile values estimated for two groups of infants born in years separated by a 15-year period, born in 2000 and in 2015, were compared. Birth weight percentiles, from the 28th to the 42nd week of gestation, were calculated using the Lambda Mu Sigma method. Estimated values revealed the birth weight standards in different weeks of gestational age for both years: 2000 and 2015. Comparison among medians estimated for infants born in these years showed the existence of significant differences among boys in the 28th, 36th, and 39th weeks and among girls in the 34th and 41st weeks of gestational age. As the period between the two measurements involves several years, environmental changes during this time period might have significantly affected the course of pregnancy and thus the birth weight. Hence, there is a need to validate the developmental norms. The reference standards should be renewed, and must be done on a periodical basis.
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Yang J, Kingsford RA, Horwood J, Epton MJ, Swanney MP, Stanton J, Darlow BA. Lung Function of Adults Born at Very Low Birth Weight. Pediatrics 2020; 145:peds.2019-2359. [PMID: 31900317 DOI: 10.1542/peds.2019-2359] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Much remains unknown about the consequences of very low birth weight (VLBW) and bronchopulmonary dysplasia (BPD) on adult lungs. We hypothesized that VLBW adults would have impaired lung function compared with controls, and those with a history of BPD would have worse lung function than those without. METHODS At age 26 to 30 years, 226 VLBW survivors of the New Zealand VLBW cohort and 100 term controls born in 1986 underwent lung function tests including spirometry, plethysmographic lung volumes, diffusing capacity of the lung for carbon monoxide, and single-breath nitrogen washout (SBN2). RESULTS An obstructive spirometry pattern was identified in 35% VLBW subjects versus 14% controls, with the majority showing mild obstruction. Compared with controls, VLBW survivors demonstrated significantly lower forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity (FVC) ratio (FEV1/FVC), forced expiratory flow at 25% to 75% of FVC and higher residual volume (RV), RV/total lung capacity (TLC) ratio (RV/TLC), decreased diffusing capacity of the lung for carbon monoxide, and increased phase III slope for SBN2. The differences persisted after adjustment for sex and smoking status. Within the VLBW group, subjects with BPD showed significant reduction in FEV1, FEV1/FVC, and forced expiratory flow at 25% to 75% of FVC, and increase in RV, RV/TLC, and phase III slope for SBN2, versus subjects without. The differences remained after adjustment for confounders. CONCLUSIONS Adult VLBW survivors showed a higher incidence of airflow obstruction, gas trapping, reduced gas exchange, and increased ventilatory inhomogeneity versus controls. The findings suggest pulmonary effects due to VLBW persist into adulthood, and BPD is a further insult on small airway function.
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Affiliation(s)
- Jun Yang
- Respiratory Physiology Laboratory and
| | | | | | - Michael J Epton
- Canterbury Respiratory Research Group, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand; and
| | | | | | - Brian A Darlow
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
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Lui K, Lee SK, Kusuda S, Adams M, Vento M, Reichman B, Darlow BA, Lehtonen L, Modi N, Norman M, Håkansson S, Bassler D, Rusconi F, Lodha A, Yang J, Shah PS. Trends in Outcomes for Neonates Born Very Preterm and Very Low Birth Weight in 11 High-Income Countries. J Pediatr 2019; 215:32-40.e14. [PMID: 31587861 DOI: 10.1016/j.jpeds.2019.08.020] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/04/2019] [Accepted: 08/08/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate outcome trends of neonates born very preterm in 11 high-income countries participating in the International Network for Evaluating Outcomes of neonates. STUDY DESIGN In a retrospective cohort study, we included 154 233 neonates admitted to 529 neonatal units between January 1, 2007, and December 31, 2015, at 240/7 to 316/7 weeks of gestational age and birth weight <1500 g. Composite outcomes were in-hospital mortality or any of severe neurologic injury, treated retinopathy of prematurity, and bronchopulmonary dysplasia (BPD); and same composite outcome excluding BPD. Secondary outcomes were mortality and individual morbidities. For each country, annual outcome trends and adjusted relative risks comparing epoch 2 (2012-2015) to epoch 1 (2007-2011) were analyzed. RESULTS For composite outcome including BPD, the trend decreased in Canada and Israel but increased in Australia and New Zealand, Japan, Spain, Sweden, and the United Kingdom. For composite outcome excluding BPD, the trend decreased in all countries except Spain, Sweden, Tuscany, and the United Kingdom. The risk of composite outcome was lower in epoch 2 than epoch 1 in Canada (adjusted relative risks 0.78; 95% CI 0.74-0.82) only. The risk of composite outcome excluding BPD was significantly lower in epoch 2 compared with epoch 1 in Australia and New Zealand, Canada, Finland, Japan, and Switzerland. Mortality rates reduced in most countries in epoch 2. BPD rates increased significantly in all countries except Canada, Israel, Finland, and Tuscany. CONCLUSIONS In most countries, mortality decreased whereas BPD increased for neonates born very preterm.
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Affiliation(s)
- Kei Lui
- Department of Newborn Care, Royal Hospital for Women and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Shoo K Lee
- Department of Pediatrics, Sinai Health System, University of Toronto, Ontario, Canada; Maternal-Infant Care Research Centre, Sinai Health System, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Satoshi Kusuda
- Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan
| | - Mark Adams
- Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Maximo Vento
- Spanish Neonatal Network, Health Research Institute La Fe, Avenida Fernando Abril Martorell, Valencia, Spain
| | - Brian Reichman
- Israel Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - Brian A Darlow
- Department of Paediatrics, University of Otago, Christchurch, Canterbury, New Zealand
| | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland; Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Neena Modi
- UK Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, United Kingdom
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Stellan Håkansson
- Department of Clinical Science/Pediatrics, Umeå University, Umeå, Sweden
| | - Dirk Bassler
- Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Franca Rusconi
- Unit of Epidemiology Meyer Children's University Hospital and Regional Health Agency, Florence, Italy
| | - Abhay Lodha
- Pediatrics & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Junmin Yang
- Maternal-Infant Care Research Centre, Sinai Health System, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Sinai Health System, University of Toronto, Ontario, Canada; Maternal-Infant Care Research Centre, Sinai Health System, Toronto, Ontario, Canada
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Gagliardi L, Basso O. Maternal hypertension and survival in singletons and twins born at 23-29 weeks: not just one answer…. Pediatr Res 2019; 85:697-702. [PMID: 30763949 DOI: 10.1038/s41390-019-0337-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/17/2019] [Accepted: 02/05/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND To describe the association between maternal hypertension (chronic and gestational, MH) and mortality in very preterm singletons and twins, focusing on how estimates depend on gestational age (GA) and size at birth. METHODS We estimated relative risks of in-hospital death in 12,320 singletons (MH: 22.4%) and 4381 twins (MH: 10.6%) born at 23-29 weeks in the Italian Neonatal Network (89 hospitals, 2008-2016). RESULTS Babies with MH had higher GA and were more frequently small-for-gestational age (SGA), especially singletons. In crude analyses, MH was associated with lower mortality in singletons. In multivariable analyses, the effects of GA and size differed between twins and singletons with and without MH. The best-fitting models included continuous birth weight (rather than SGA) and were stratified by GA. In these models, MH was associated with lower mortality in singletons-but not twins-born after week 25. CONCLUSIONS In this cohort of very preterm infants, the association between MH and mortality differed between singletons and twins and across strata of GA at birth. These estimates cannot be interpreted causally, but suggest that, from a descriptive/predictive standpoint, singletons with MH born after week 25 have lower mortality than singletons born to women without MH.
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Affiliation(s)
- Luigi Gagliardi
- Department of Woman and Child Health, Pediatrics and Neonatology Division, Ospedale Versilia, Viareggio, AUSL Toscana Nord Ovest, Pisa, Italy.
| | - Olga Basso
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics, and Occ. Health, McGill University, Montreal, QC, Canada
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Predictors of mortality for preterm infants with intraventricular hemorrhage: a population-based study. Childs Nerv Syst 2018; 34:2203-2213. [PMID: 29987373 PMCID: PMC6326904 DOI: 10.1007/s00381-018-3897-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/29/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE The goal of this longitudinal, population-level study was to examine factors affecting mortality in preterm infants with intraventricular hemorrhage (IVH). METHODS The study examined patients who were born at 36 weeks estimated gestational age (EGA) or less with a diagnosis of IVH between the years 2005 and 2014 using data from the New York and Nebraska State Inpatient Databases. Potential predictors for mortality were investigated with multivariable survival analysis. RESULTS The cohort included 7437 preterm infants with IVH. All-cause inpatient mortality occurred in 746 (10.0%). The majority of deaths were in infants born at less than 25 weeks EGA (378 or 50.7%) and with birthweight less than 750 g (459 or 61.5%). Mortality was highest for children with grade IV IVH (306/848 or 36.1%), followed by grades III (203/955 or 21.3%), II (103/1328 or 7.8%), and I (134/4306 or 3.1%). Hydrocephalus was diagnosed within 6 months in 627 (8.4%) patients, with cerebrospinal fluid shunts required in 237 (3.2%). Shunts were eventually revised in 122 (51.5% of shunts), and 43 (18.1%) had infections. Multivariable Cox survival analyses found male sex (HR 1.3 [95% CI 1.1-1.5]), Asian race (HR 1.5 [1.1-2.2]), lower EGA (HR 9.9 [6.3-15.5] for < 25 weeks), higher IVH grade (HR 6.1 [4.9-7.6] for grade IV), gastrostomy (HR 4.0 [2.0-7.7]), tracheostomy (HR 3.5 [1.7-7.1]), and shunt infection (HR 3.2 [1.0-9.9]) to be independently associated with increased mortality risk. CONCLUSIONS This database is the first of its kind assembled for population-based investigations of long-term neurosurgical outcomes in preterm infants with IVH.
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Dyson RM, Palliser HK, Wilding N, Kelly MA, Chwatko G, Glowacki R, Berry MJ, Ni X, Wright IMR. Microvascular circulatory dysregulation driven in part by cystathionine gamma-lyase: A new paradigm for cardiovascular compromise in the preterm newborn. Microcirculation 2018; 26:e12507. [PMID: 30276964 DOI: 10.1111/micc.12507] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 09/24/2018] [Accepted: 09/27/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE H2 S may explain the dysregulation of microvascular tone associated with poor outcome following preterm birth. In adult vasculature, H2 S is predominantly produced by CSE. We hypothesized that vascular CSE activity contributes to microvascular tone regulation during circulatory transition. METHODS Preterm (GA62) and full-term (GA69) guinea pig fetuses and neonates were studied. Microvascular blood flow was assessed by laser Doppler flowmetry. Thiosulfate, primary urinary metabolite of H2 S, was determined by high-performance liquid chromatography. Real-time H2 S production was assessed using a microrespiration system in fetal and postnatal (10, 24 hours) skin and heart samples. CSE contribution was investigated by inhibition via propargylglycine. RESULTS In preterm animals, postnatal H2 S production capacity in peripheral vasculature increased significantly and was significantly reduced by the inhibition of CSE. Urinary thiosulfate correlated with both microvascular blood flow and capacity of the vasculature to produce H2 S. H2 S produced via CSE did not correlate directly with microvascular blood flow. CONCLUSIONS In preterm neonates, H2 S production increases during fetal-to-neonatal transition and CSE contribution to total H2 S increases postnatally. CSE-dependent mechanisms may therefore underpin the increase in H2 S production over the first 72 hours of life in preterm human neonates, associated with both central and peripheral cardiovascular instability.
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Affiliation(s)
- Rebecca M Dyson
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia.,Department of Paediatrics and Child Health Research, Graduate Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Mothers and Babies Research Centre, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Discipline of Paediatrics and Child Health, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Department of Paediatrics and Child Health, University of Otago Wellington, Wellington, New Zealand
| | - Hannah K Palliser
- Mothers and Babies Research Centre, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia
| | - Nicole Wilding
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia.,Department of Paediatrics and Child Health Research, Graduate Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Megan A Kelly
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia.,Department of Paediatrics and Child Health Research, Graduate Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,School of Biological Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Grazyna Chwatko
- Department of Environmental Chemistry, Faculty of Chemistry, University of Lodz, Lodz, Poland
| | - Rafal Glowacki
- Department of Environmental Chemistry, Faculty of Chemistry, University of Lodz, Lodz, Poland
| | - Mary J Berry
- Department of Paediatrics and Child Health, University of Otago Wellington, Wellington, New Zealand
| | - Xin Ni
- Department of Physiology, Second Military Medical University, Shanghai, China
| | - Ian M R Wright
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia.,Department of Paediatrics and Child Health Research, Graduate Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Mothers and Babies Research Centre, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Discipline of Paediatrics and Child Health, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
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14
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Villeneuve E, Landa P, Allen M, Spencer A, Prosser S, Gibson A, Kelsey K, Mujica-Mota R, Manktelow B, Modi N, Thornton S, Pitt M. A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BackgroundThere is an inherent tension in neonatal services between the efficiency and specialised care that comes with centralisation and the provision of local services with associated ease of access and community benefits. This study builds on previous work in South West England to address these issues at a national scale.Objectives(1) To develop an analytical framework to address key issues of neonatal service configuration in England, (2) to investigate visualisation tools to facilitate the communication of findings to stakeholder groups and (3) to assess parental preferences in relation to service configuration alternatives.Main outcome measuresThe ability to meet nurse staffing guidelines, volumes of units, costs, mortality, number and distance of transfers, travel distances and travel times for parents.DesignDescriptive statistics, location analysis, mathematical modelling, discrete event simulation and economic analysis were used. Qualitative methods were used to interview policy-makers and parents. A parent advisory group supported the study.SettingNHS neonatal services across England.DataNeonatal care data were sourced from the National Neonatal Research Database. Information on neonatal units was drawn from the National Neonatal Audit Programme. Geographic and demographic data were sourced from the Office for National Statistics. Travel time data were retrieved via a geographic information system. Birth data were sourced from Hospital Episode Statistics. Parental cost data were collected via a survey.ResultsLocation analysis shows that to achieve 100% of births in units with ≥ 6000 births per year, the number of birth centres would need to be reduced from 161 to approximately 72, with more parents travelling > 30 minutes. The maximum number of neonatal intensive care units (NICUs) needed to achieve 100% of very low-birthweight infants attending high-volume units is 36 with existing NICUs, or 48 if NICUs are located wherever there is currently a neonatal unit of any level. Simulation modelling further demonstrated the workforce implications of different configurations. Mortality modelling shows that the birth of very preterm infants in high-volume hospitals reduces mortality (a conservative estimate of a 1.2-percentage-point lower risk) relative to these births in other hospitals. It is currently not possible to estimate the impact of mortality for infants transferred into NICUs. Cost modelling shows that the mean length of stay following a birth in a high-volume hospital is 9 days longer and the mean cost is £5715 more than for a birth in another neonatal unit. In addition, the incremental cost per neonatal life saved is £460,887, which is comparable to other similar life-saving interventions. The analysis of parent costs identified unpaid leave entitlement, food, travel, accommodation, baby care and parking as key factors. The qualitative study suggested that central concerns were the health of the baby and mother, communication by medical teams and support for families.LimitationsThe following factors could not be modelled because of a paucity of data – morbidity outcomes, the impact of transfers and the maternity/neonatal service interface.ConclusionsAn evidence-based framework was developed to inform the configuration of neonatal services and model system performance from the perspectives of both service providers and parents.Future workTo extend the modelling to encompass the interface between maternity and neonatal services.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Emma Villeneuve
- National Institute for Health Research: Collaborations for Leadership in Applied Health Research and Care – South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Paolo Landa
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Michael Allen
- National Institute for Health Research: Collaborations for Leadership in Applied Health Research and Care – South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Anne Spencer
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Sue Prosser
- Neonatal Unit, Royal Devon and Exeter Hospital, Exeter, UK
| | - Andrew Gibson
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Katie Kelsey
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ruben Mujica-Mota
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Brad Manktelow
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Neena Modi
- Section of Neonatal Medicine, Department of Medicine, Imperial College London, London, UK
| | - Steve Thornton
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Martin Pitt
- National Institute for Health Research: Collaborations for Leadership in Applied Health Research and Care – South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
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Roro EM, Sisay MM, Sibley LM. Determinants of perinatal mortality among cohorts of pregnant women in three districts of North Showa zone, Oromia Region, Ethiopia: Community based nested case control study. BMC Public Health 2018; 18:888. [PMID: 30021557 PMCID: PMC6052561 DOI: 10.1186/s12889-018-5757-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 06/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Statistics indicate that Ethiopia has made remarkable progress in reducing child mortality. It is however estimated that there is high rate of perinatal mortality although there is scarcity of data due to a lack of vital registration in the country. This study was conducted with the purpose of assessing the determinants and causes of perinatal mortality among babies born from cohorts of pregnant women in three selected districts of North Showa Zone, Oromia Region, Ethiopia. The study used community based data, which is believed to provide more representative and reliable information and also aimed to narrow the data gap on perinatal mortality. METHODS A community based nested case control study was conducted among 4438 (cohorts of) pregnant women. The cohort was followed up between March 2011 to December 2012 in three districts of Oromia region, Ethiopia, until delivery. The World Health Organization verbal autopsy questionnaire for neonatal death was used to collect data. A binary logistic regression model was used to identify determinants of perinatal mortality. Causes of deaths were assigned by a pediatrician and neonatologist. Cases are stillbirths and early neonatal death. Control are live births surviving of the perinatal period' RESULT: A total of 219 newborns (73 cases and 146 controls) were included in the analysis. Perinatal mortality rate was 16.5 per 1000 births. Mothers aged 35 years and above had a higher risk of losing their newborn babies to perinatal deaths than younger mothers [AOR 7.59, (95% CI, 1.91-30.10)]. Babies born to mothers who had a history of neonatal deaths were also more likely to die during the perinatal period than their counterparts [AOR 5.42, (95% CI, 2.27-12.96)]. Preterm births had a higher risk of perinatal death than term babies [AOR 8.58, (95% CI, 2.27-32.38)]. Similarly, male babies were at higher risk than female babies [AOR 5.47, (95% CI, 2.50-11.99)]. Multiple birth babies had a higher chance of dying within the perinatal period than single births [AOR 3.59, (95% CI, 1.20-10.79)]. Home delivery [AOR 0.23, (95% CI, 0.08-0.67)] was found to reduce perinatal deaths. Asphyxia, sepsis and chorioamnionitis were among the leading causes of perinatal deaths. CONCLUSION This study reported a lower perinatal mortality rate. The main causes of perinatal death identified were often related to maternal factors. There is still a need for greater focus on these interrelated issues for further intervention.
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Affiliation(s)
- Elias Merdassa Roro
- School of Public Health, College of Health Sciences, Wollega University, Western, Ethiopia
| | - Mitike Molla Sisay
- School of Public Health College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia
- School of Public Health College of Health Sciences, Post-Doctoral Fellow Emory University, Georgia, USA
| | - Lynn M. Sibley
- Nell Hodgson Woodruff School of Nursing, Rollins School of Public Health, Emory University, PI Maternal and Newborn Health in Ethiopia Partnership (MaNHEP), Georgia, USA
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16
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Kelly LE, Shah PS, Håkansson S, Kusuda S, Adams M, Lee SK, Sjörs G, Vento M, Rusconi F, Lehtonen L, Reichman B, Darlow BA, Lui K, Feliciano LS, Gagliardi L, Bassler D, Modi N. Perinatal health services organization for preterm births: a multinational comparison. J Perinatol 2017; 37:762-768. [PMID: 28383541 DOI: 10.1038/jp.2017.45] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 02/28/2017] [Accepted: 03/03/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore population characteristics, organization of health services and comparability of available information for very low birth weight or very preterm neonates born before 32 weeks' gestation in 11 high-income countries contributing data to the International Network for Evaluating Outcomes of Neonates (iNeo). STUDY DESIGN We obtained population characteristics from public domain sources, conducted a survey of organization of maternal and neonatal health services and evaluated the comparability of data contributed to the iNeo collaboration from Australia, Canada, Finland, Israel, Italy, Japan, New Zealand, Spain, Sweden, Switzerland and UK. RESULTS All countries have nationally funded maternal/neonatal health care with >90% of women receiving prenatal care. Preterm birth rate, maternal age, and neonatal and infant mortality rates were relatively similar across countries. Most (50 to >95%) between-hospital transports of neonates born at non-tertiary units were conducted by designated transport teams; 72% (8/11 countries) had designated transfer and 63% (7/11 countries) mandate the presence of a physician. The capacity of 'step-down' units varied between countries, with capacity for respiratory care available in <10% to >75% of units. Heterogeneity in data collection processes for benchmarking and quality improvement activities were identified. CONCLUSIONS Comparability of healthcare outcomes for very preterm low birth weight neonates between countries requires an evaluation of differences in population coverage, healthcare services and meta-data.
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Affiliation(s)
- L E Kelly
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, ON, Canada
| | - P S Shah
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, ON, Canada.,Department of Pediatrics, Mount Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, ON, Canada
| | - S Håkansson
- Department of Pediatrics/Neonatal Services, Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden
| | - S Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
| | - M Adams
- Department of Neonatology, Swiss Neonatal Network, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, Switzerland, Switzerland
| | - S K Lee
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, ON, Canada.,Department of Pediatrics, Mount Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, ON, Canada
| | - G Sjörs
- Department of Pediatrics/Neonatal Services, Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden
| | - M Vento
- Spanish Neonatal Network, Health Research Institute La Fe, Valencia, Spain
| | - F Rusconi
- Unit of Epidemiology, TIN Toscane Online, Meyer Children's University Hospital, Regional Health Agency, Florence, Italy
| | - L Lehtonen
- Department of Pediatrics, Finnish Medical Birth Register and Register of Congenital Malformations, Turku University Hospital, Kiinamyllynkatu 4-8, Turku, Finland
| | - B Reichman
- Israel Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer, Israel
| | - B A Darlow
- Department of Paediatrics, Australia and New Zealand Neonatal Network, University of Otago, Christchurch, New Zealand
| | - K Lui
- National Perinatal Epidemiology and Statistic Unit, Australian and New Zealand Neonatal Network, Royal Hospital for Women, University of New South Wales, Randwick, NSW, Australia
| | - L S Feliciano
- Spanish Neonatal Network, Health Research Institute La Fe, Valencia, Spain
| | - L Gagliardi
- Division of Pediatrics and Neonatology, Ospedale Versilia, Viareggio, Italy
| | - D Bassler
- Department of Neonatology, Swiss Neonatal Network, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, Switzerland, Switzerland
| | - N Modi
- Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, UK Neonatal Collaborative, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
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17
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Liu S, Metcalfe A, León JA, Sauve R, Kramer MS, Joseph KS. Evaluation of the INTERGROWTH-21st project newborn standard for use in Canada. PLoS One 2017; 12:e0172910. [PMID: 28257473 PMCID: PMC5336248 DOI: 10.1371/journal.pone.0172910] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 12/21/2016] [Indexed: 11/19/2022] Open
Abstract
Objective To evaluate the performance of the INTERGROWTH-21st Project newborn standard vis-a-vis the current Canadian birth weight-for-gestational age reference. Methods All hospital-based singleton live births in Canada (excluding Quebec) between 2002 and 2012 with a gestational age between 33 and 42 weeks were included using information obtained from the Canadian Institute for Health Information. Small- and large-for gestational age centile categories of the INTERGROWTH standard and Canadian reference were contrasted in terms of frequency distributions and rates of composite neonatal morbidity/mortality. Results Among 2,753,817 singleton live births, 0.87% and 9.63% were <3rd centile and >97th centile, respectively, of the INTERGROWTH standard, while 2.27% and 3.55% were <3rd centile and >97th centile, respectively, of the Canadian reference. Infants <3rd centile and >97th centile had a composite neonatal morbidity/mortality rate of 46.4 and 12.9 per 1,000 live births, respectively, under the INTERGROWTH standard and 30.9 and 16.6 per 1,000 live births, respectively, under the Canadian reference. The INTERGROWTH standard <3rd centile and >97th centile categories had detection rates of 3.14% and 9.74%, respectively, for composite neonatal morbidity/ mortality compared with 5.48% and 4.60%, respectively for the Canadian reference. Similar patterns were evident in high- and low-risk subpopulations. Conclusions The centile distribution of the INTERGROWTH newborn standard is left shifted compared with the Canadian reference, and this shift alters the frequencies and neonatal morbidity/mortality rates associated with specific centile categories. Further outcome-based research is required for defining abnormal growth categories before the INTERGROWTH newborn standard can be used.
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Affiliation(s)
- Shiliang Liu
- Maternal, Child and Youth Health, Surveillance and Epidemiology Division, Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, Canada
- * E-mail:
| | - Amy Metcalfe
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Juan Andrés León
- Maternal, Child and Youth Health, Surveillance and Epidemiology Division, Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, Canada
| | - Reg Sauve
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Michael S. Kramer
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - K. S. Joseph
- Department of Obstetrics and Gynaecology and the School of Population and Public Health, University of British Columbia and the Children’s and Women’s Hospital and Health Centre of British Columbia, Vancouver, Canada
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Schindler T, Koller-Smith L, Lui K, Bajuk B, Bolisetty S. Causes of death in very preterm infants cared for in neonatal intensive care units: a population-based retrospective cohort study. BMC Pediatr 2017; 17:59. [PMID: 28222717 PMCID: PMC5319155 DOI: 10.1186/s12887-017-0810-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 02/13/2017] [Indexed: 11/13/2022] Open
Abstract
Background While there are good data to describe changing trends in mortality and morbidity rates for preterm populations, there is very little information on the specific causes and pattern of death in terms of age of vulnerability. It is well established that mortality increases with decreasing gestational age but there are limited data on the specific causes that account for this increased mortality. The aim of this study was to establish the common causes of hospital mortality in a regional preterm population admitted to a neonatal intensive care unit (NICU). Methods Retrospective analysis of prospectively collected data of the Neonatal Intensive Care Units' (NICUS) Data Collection of all 10 NICUs in the region. Infants <32 weeks gestation without major congenital anomalies admitted from 2007 to 2011 were included. Three authors reviewed all cases to agree upon the immediate cause of death. Results There were 345 (7.7%) deaths out of 4454 infants. The most common cause of death across all gestational groups was major IVH (cause-specific mortality rate [CMR] 22 per 1000 infants), followed by acute respiratory illnesses [ARI] (CMR 21 per 1000 infants) and sepsis (CMR 12 per 1000 infants). The most common cause of death was different in each gestational group (22–25 weeks [ARI], 26–28 weeks [IVH] and 29–31 weeks [perinatal asphyxia]). Pregnancy induced hypertension, antenatal steroids and chorioamnionitis were all associated with changes in CMRs. Deaths due to ARI or major IVH were more likely to occur at an earlier age (median [quartiles] 1.4 [0.3–4.4] and 3.6 [1.9–6.6] days respectively) in comparison to NEC and miscellaneous causes (25.2 [15.4–37.3] and 25.8 [3.2–68.9] days respectively). Conclusions Major IVH and ARI were the most common causes of hospital mortality in this extreme to very preterm population. Perinatal factors have a significant impact on cause-specific mortality. The varying timing of death provides insight into the prolonged vulnerability for diseases such as necrotising enterocolitis in our preterm population.
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Affiliation(s)
- Tim Schindler
- Faculty of Medicine, University of New South Wales, Sydney, Australia. .,Department of Newborn Care, Royal Hospital for Women, Sydney, Australia.
| | | | - Kei Lui
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,Department of Newborn Care, Royal Hospital for Women, Sydney, Australia
| | - Barbara Bajuk
- New South Wales Pregnancy and Newborn Services Network (PSN), Sydney, Australia
| | - Srinivas Bolisetty
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,Department of Newborn Care, Royal Hospital for Women, Sydney, Australia
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Bassareo PP, Marras AR, Cugusi L, Zedda AM, Mercuro G. The reasons why cardiologists should consider prematurity at birth and intrauterine growth retardation among risk factors. J Cardiovasc Med (Hagerstown) 2017; 17:323-9. [PMID: 26627499 DOI: 10.2459/jcm.0000000000000338] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The survival percentage of infants born preterm has risen steadily worldwide thanks to the giant steps forward made in the field of perinatal (the period immediately after birth) and neonatal (the first 4 weeks of birth following delivery) medicine. However, prematurity at birth and consequent low birth weight still represent the major causes of neonatal morbidity and mortality. Infants born preterm are at high risk of developing neurological, ophthalmological, and gastrointestinal complications as well. Furthermore, extensive more recent epidemiological findings have demonstrated an increase in risk factors and a higher mortality rate due to cardiovascular causes in patients born preterm and/or with intrauterine growth restriction. The aim of this review is to provide scientific evidence about how the cardiovascular system may be negatively influenced by prematurity and by a low birth weight that should by rights be viewed as new cardiovascular risk factors. This condition is referred to as 'cardiovascular perinatal programming'. In the light of the above, an early, constant, and prolonged cardiovascular follow-up should be implemented in former preterm individuals.
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Affiliation(s)
- Pier P Bassareo
- Department of Medical Sciences 'M. Aresu', University of Cagliari, Cagliari, Italy
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20
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Torchin H, Ancel PY. [Epidemiology and risk factors of preterm birth]. ACTA ACUST UNITED AC 2016; 45:1213-1230. [PMID: 27789055 DOI: 10.1016/j.jgyn.2016.09.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 09/14/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To synthesize the available evidence regarding the incidence and several risk factors of preterm birth. To describe neonatal outcomes according to gestational age and to the context of delivery. MATERIALS AND METHODS Consultation of the Medline database. RESULTS In 2010, 11% of live births (15 million babies) occurred before 37 completed weeks of gestation worldwide. About 85% of these births were moderate to late preterm babies (32-36 weeks), 10% were very preterm babies (28-31 weeks) and 5% were extremely preterm babies (<28 weeks). In France, premature birth concerns 60,000 neonates every year, 12,000 of whom are born before 32 completed weeks of gestation. Half of them are delivered after spontaneous onset of labor or preterm premature rupture of the membranes, and the other half are provider-initiated preterm births. Several maternal factors are associated with preterm birth, including sociodemographic, obstetrical, psychological, and genetic factors; paternal and environmental factors are also involved. Gestational age is highly associated with neonatal mortality and with short- and long-term morbidities. Pregnancy complications and the context of delivery also have an impact on neonatal outcomes. CONCLUSION Preterm birth is one of the leading cause of the under-five mortality and of neurodevelopmental impairment worldwide; it remains a major public health issue.
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Affiliation(s)
- H Torchin
- Inserm U1153, DHU risques et grossesse, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique, centre de recherche épidémiologie et statistique Sorbonne Paris Cité, bâtiment Port-Royal, 53, avenue de l'Observatoire, 75014 Paris, France; Université Paris Descartes, Paris, France.
| | - P-Y Ancel
- Inserm U1153, DHU risques et grossesse, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique, centre de recherche épidémiologie et statistique Sorbonne Paris Cité, bâtiment Port-Royal, 53, avenue de l'Observatoire, 75014 Paris, France; URC - CIC P1419, groupe hospitalier Cochin Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 75014 Paris, France; Université Paris Descartes, Paris, France
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Predicting 2-y outcome in preterm infants using early multimodal physiological monitoring. Pediatr Res 2016; 80:382-8. [PMID: 27089498 DOI: 10.1038/pr.2016.92] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 03/16/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Preterm infants are at risk of adverse outcome. The aim of this study is to develop a multimodal model, including physiological signals from the first days of life, to predict 2-y outcome in preterm infants. METHODS Infants <32 wk gestation had simultaneous multi-channel electroencephalography (EEG), peripheral oxygen saturation (SpO2), and heart rate (HR) monitoring. EEG grades were combined with gestational age (GA) and quantitative features of HR and SpO2 in a logistic regression model to predict outcome. Bayley Scales of Infant Development-III assessed 2-y neurodevelopmental outcome. A clinical course score, grading infants at discharge as high or low morbidity risk, was used to compare performance with the model. RESULTS Forty-three infants were included: 27 had good outcomes, 16 had poor outcomes or died. While performance of the model was similar to the clinical course score graded at discharge, with an area under the receiver operator characteristic (AUC) of 0.83 (95% confidence intervals (CI): 0.69-0.95) vs. 0.79 (0.66-0.90) (P = 0.633), the model was able to predict 2-y outcome days after birth. CONCLUSION Quantitative analysis of physiological signals, combined with GA and graded EEG, shows potential for predicting mortality or delayed neurodevelopment at 2 y of age.
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Vincer MJ, Armson BA, Allen VM, Allen AC, Stinson DA, Whyte R, Dodds L. An Algorithm for Predicting Neonatal Mortality in Threatened Very Preterm Birth. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 37:958-65. [PMID: 26629716 DOI: 10.1016/s1701-2163(16)30045-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To develop a prediction model for neonatal mortality using information readily available in the antenatal period. METHODS A multiple logistic regression model of a complete population-based geographically defined cohort of very preterm infants of 23+0 to 30+6 weeks' gestation was used to identify antenatal factors which were predictive of mortality in this population. Infants lt; 23 weeks and those with major anomalies were excluded. RESULTS Between 1996 and 2012, 1240 live born infants lt; 31 weeks' gestation were born to women residing in Nova Scotia. Decreasing gestational age strongly predicted an increased mortality rate. Other factors significantly contributing to increased mortality included classification as small for gestational age, oligohydramnios, maternal psychiatric disorders, antenatal antibiotic therapy, and monochorionic twins. Reduced neonatal mortality was associated with antenatal use of antihypertensive agents and use of corticosteroids of any duration of therapy given at least 24 hours before delivery. An algorithm was developed to estimate the risk of mortality without the need for a calculator. CONCLUSION Prediction of the probability of neonatal mortality is influenced by maternal and fetal factors. An algorithm to estimate the risk of mortality facilitates counselling and informs shared decision making regarding obstetric management.
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Affiliation(s)
- Michael J Vincer
- The Perinatal Follow-Up Program of Nova Scotia, IWK Health Centre, Halifax NS; Department of Pediatrics, Dalhousie University, Halifax NS; Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS
| | - B Anthony Armson
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS
| | - Victoria M Allen
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS
| | - Alexander C Allen
- Department of Pediatrics, Dalhousie University, Halifax NS; Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS; The Perinatal Epidemiology Research Unit, Department of Pediatrics, Dalhousie University, Halifax NS
| | - Dora A Stinson
- The Perinatal Follow-Up Program of Nova Scotia, IWK Health Centre, Halifax NS; Department of Pediatrics, Dalhousie University, Halifax NS; Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS
| | - Robin Whyte
- Department of Pediatrics, Dalhousie University, Halifax NS
| | - Linda Dodds
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS; The Perinatal Epidemiology Research Unit, Department of Pediatrics, Dalhousie University, Halifax NS
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McBride CA, Bernstein IM, Badger GJ, Horbar JD, Soll RF. The effect of maternal hypertension on mortality in infants 22, 29weeks gestation. Pregnancy Hypertens 2015; 5:362-6. [PMID: 26597755 DOI: 10.1016/j.preghy.2015.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the effect of maternal hypertension on mortality risk prior to discharge, in infants 22+0 to 29+6weeks gestational age. STUDY DESIGN We evaluated 88,275 North American infants whose births were recorded in Vermont Oxford Network centers between 2008 and 2011 Infants born between 22+0 and 29+6weeks gestational age were evaluated in 2-week gestational age cohorts and followed until death or discharge. Logistic regression was used to adjust for birth weight, antenatal steroid exposure, infant sex, maternal race, inborn/outborn, prenatal care and birth year. RESULTS 21,896 infants were born to hypertensive mothers; 13% died prior to Neonatal Intensive Care Unit discharge compared to 20% of the 66,379 infants born to mothers without hypertension. After adjustment, infants had significantly lower mortality compared to preterm infants not born to hypertensive mothers, at all gestational ages examined (22/23: odds ratio (OR)=0.65 (95% Confidence Interval (CI): 0.55, 0.77; 24/25); OR=0.77 (95% CI: 0.71, 0.84); 26/27: OR=0.66 (95% CI: 0.59, 0.74); 28/29: OR=0.58 (95% CI: 0.51, 0.67). Additionally, births associated with maternal hypertension increase dramatically by gestational age, resulting in a larger proportion of births associated with maternal hypertension at later gestational ages. CONCLUSIONS Preterm birth due to any cause carries significant risk of mortality, especially at the earliest of viable gestational ages. Maternal hypertension independently influences mortality, with lower odds of mortality seen in infants born to hypertensive mothers, after adjustment, and should be taken into consideration as an element in counseling parents.
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Affiliation(s)
- Carole A McBride
- University of Vermont, Department of Obstetrics, Gynecology and Reproductive Sciences, Burlington, VT 05405, United States.
| | - Ira M Bernstein
- University of Vermont, Department of Obstetrics, Gynecology and Reproductive Sciences, Burlington, VT 05405, United States; Vermont Oxford Network, Burlington, VT 05401, United States
| | - Gary J Badger
- University of Vermont, Department of Medical Biostatistics, Burlington, VT 05405, United States
| | - Jeffrey D Horbar
- University of Vermont, Department of Pediatrics, Burlington, VT 05405, United States; Vermont Oxford Network, Burlington, VT 05401, United States
| | - Roger F Soll
- University of Vermont, Department of Pediatrics, Burlington, VT 05405, United States; Vermont Oxford Network, Burlington, VT 05401, United States
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Lim JW, Chung SH, Kang DR, Kim CR. Risk Factors for Cause-specific Mortality of Very-Low-Birth-Weight Infants in the Korean Neonatal Network. J Korean Med Sci 2015; 30 Suppl 1:S35-44. [PMID: 26566356 PMCID: PMC4641062 DOI: 10.3346/jkms.2015.30.s1.s35] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/27/2015] [Indexed: 11/20/2022] Open
Abstract
This study attempted to assess the risk factors for mortality of very-low-birth-weight (VLBW) infants in the neonatal intensive care unit (NICU, n=2,386). Using data from the Korean Neonatal Network, we investigated infants with birth weights <1,500 g and gestational ages (GAs) of 22-31 weeks born between January 2013 and June 2014. Cases were defined as death at NICU discharge. Controls were randomly selected from live VLBW infants and frequency matched to case subjects by GA. Relevant variables were compared between the cases (n=236) and controls (n=236) by Cox proportional hazards regression to determine their associations with cause-specific mortality (cardiorespiratory, neurologic, infection, gastrointestinal, and others). In a Cox regression analysis, cardiorespiratory death were associated with a foreign mother (hazard ratio, HR, 4.33; 95% confidence interval, CI, 2.08-9.02), multiple gestation (HR, 1.65; 95% CI, 1.07-2.54), small for gestational age (HR, 2.06; 95% CI, 1.25-3.41), male gender (HR, 1.69; 95% CI, 1.10-2.60), Apgar score ≤3 at 5 min (HR, 1.97; 95% CI, 1.18-3.31), and delivery room resuscitation (HR, 2.60; 95% CI, 1.53-4.40). An Apgar score ≤3 at 5 min was also associated with neurological death (HR, 2.95; 95% CI, 1.29-6.73). Death due to neonatal infection was associated with outborn delivery (HR, 5.09; 95% CI, 1.46-17.74). Antenatal steroid and preterm premature rupture of membranes reduced risk of cardiorespiratory death (HR, 0.43; 95% CI, 0.27-0.67) and gastrointestinal death (HR, 0.30; 95% CI, 0.13-0.70), respectively. In conclusion, foreign mother, multiple gestation, small gestation age, male gender, Apgar score ≤3 at 5 min, and resuscitation in the delivery room are associated with cardiorespiratory mortality of VLBW infants in NICU. An Apgar score ≤3 at 5 min and outborn status are associated with neurological and infection mortality, respectively.
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Affiliation(s)
- Jae Woo Lim
- Department of Pediatrics, College of Medicine, Konyang University, Daejon, Korea
| | - Sung-Hoon Chung
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Dae Ryong Kang
- Office of Biostatistics, School of Medicine, Ajou University, Suwon, Korea
| | - Chang-Ryul Kim
- Department of Pediatrics, College of Medicine, Hanyang University, Seoul, Korea
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Yeo KT, Lee QY, Quek WS, Wang YA, Bolisetty S, Lui K. Trends in Morbidity and Mortality of Extremely Preterm Multiple Gestation Newborns. Pediatrics 2015; 136:263-71. [PMID: 26169427 DOI: 10.1542/peds.2014-4075] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine the risk of mortality and major morbidities in extremely preterm multiple gestation infants compared with singletons over time. METHODS This is a retrospective study of 15,402 infants born ≤27 weeks' gestation, admitted to NICUs in the Australian and New Zealand Neonatal Network from 1995 to 2009. Mortality and major morbidities were compared between singletons and multiples across three 5-year epochs. RESULTS Extreme preterm multiples were more likely to have lower birth weight; higher maternal age; and higher rates of assisted conception, antenatal steroid use, and cesarean delivery compared with singletons. The mortality rate was significantly higher in multiples compared with singletons even as there was a trend of decreasing gestational-age stratified mortality in multiples over the time period investigated. The rates of major morbidities or composite adverse outcomes were not different between multiples and singletons across all epochs. The adjusted odds ratio (AOR) for mortality in multiples was significantly higher in multiples compared with singletons (AOR 1.20, 95% confidence interval [CI] 1.08-1.34). There were no differences in the adjusted odds for poor outcomes in multiples compared with singletons in the most recent epoch: mortality (AOR 1.00, 95% CI 0.84-1.19), major morbidity (0.95, 95% CI 0.81-1.10), and composite adverse outcome (0.96, 95% CI 0.83-1.11). CONCLUSIONS Over the 15-year period, the odds for mortality in extremely preterm NICU infants of multiple gestation was significantly higher compared with singletons. The adjusted odds of poor outcomes in multiples were not significantly different from that of singletons in the most recent epoch.
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Affiliation(s)
- Kee Thai Yeo
- Department of Newborn Care, Royal Hospital for Women, Randwick, Australia; Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | - Qin Ying Lee
- School of Women's and Child's Health, University of New South Wales, Sydney, Australia; and
| | - Wei Shern Quek
- Department of Newborn Care, Royal Hospital for Women, Randwick, Australia;Department of Neonatology, KK Women's and Children's Hospital, Singapore;School of Women's and Child's Health, University of New South Wales, Sydney, Australia; andFaculty of Health, University of Technology, Sydney, Australia
| | | | - Srinivas Bolisetty
- Department of Newborn Care, Royal Hospital for Women, Randwick, Australia; School of Women's and Child's Health, University of New South Wales, Sydney, Australia; and
| | - Kei Lui
- Department of Newborn Care, Royal Hospital for Women, Randwick, Australia; School of Women's and Child's Health, University of New South Wales, Sydney, Australia; and
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Bolisetty S, Legge N, Bajuk B, Lui K. Preterm infant outcomes in New South Wales and the Australian Capital Territory. J Paediatr Child Health 2015; 51:713-21. [PMID: 25644196 DOI: 10.1111/jpc.12848] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/01/2015] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to provide updated information on gestation-specific hospital outcomes of extreme to very preterm infants admitted to neonatal intensive care units. METHODS A population-based retrospective cohort study of infants born between 23(+0) and 31(+6) weeks gestation and admitted to a network of neonatal intensive care units between 2007 and 2011 in a well-defined geographic area of New South Wales and the Australian Capital Territory. Main outcome measures were survival and major morbidities prior to hospital discharge. RESULTS Of 4454 infants included, hospital survival rates based on gestational age alone were 27%, 59%, 76%, 85%, 91% and over 95% at 23, 24, 25, 26, 27 and 28-31 weeks, respectively. Survival rates for each week up to 29 weeks gestation differed by at least 5% when perinatal risk factors including birthweight percentile, exposure to antenatal steroids, birth outside a tertiary hospital and gender were included in the survival estimation. All the major outcome figures were then simplified and displayed in a simple, easy-to-understand preterm outcome table for counselling purposes. CONCLUSION We report the latest hospital outcomes of extreme to very preterm infants in New South Wales and the Australian Capital Territory. Survival rates based on gestational age alone may not provide the true estimate as the survival for these infants can vary based on the presence or absence of other relevant perinatal factors.
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Affiliation(s)
- Srinivas Bolisetty
- Division of Newborn Services, Royal Hospital for Women, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Nele Legge
- Division of Newborn Services, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Barbara Bajuk
- NSW Pregnancy and Newborn Services Network (PSN), Sydney, New South Wales, Australia
| | - Kei Lui
- Division of Newborn Services, Royal Hospital for Women, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
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Reid S, Bajuk B, Lui K, Sullivan EA. Comparing CRIB-II and SNAPPE-II as mortality predictors for very preterm infants. J Paediatr Child Health 2015; 51:524-528. [PMID: 25266790 DOI: 10.1111/jpc.12742] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2014] [Indexed: 11/28/2022]
Abstract
AIMS This article compares the severity of illness scoring systems clinical risk index for babies (CRIB)-II and score for neonatal acute physiology with perinatal extension (SNAPPE)-II for discriminatory ability and goodness of fit in the same cohort of babies of less than 32 weeks gestation and aims to provide validation in the Australian population. METHODS CRIB-II and SNAPPE-II scores were collected on the same cohort of preterm infants born within a 2-year period, 2003 and 2004. The discriminatory ability of each score was assessed by the area under the receiver operator characteristic curve, and goodness of fit was assessed by the Hosmer-Lemeshow (HL) test. The outcome measure was in-hospital mortality. A multivariate logistic regression model was tested for perinatal variables that might add to the risk of in-hospital mortality. RESULTS Data for both scores were available for 1607 infants. Both scores had good discriminatory ability (CRIB-II area under the curve 0.913, standard error (SE) 0.014; SNAPPE-II area under the curve 0.907, SE 0.012) and adequate goodness of fit (HL χ2 = 11.384, 8 degrees of freedom, P = 0.183 for CRIB-II; HL χ2 = 4.319, 7 degrees of freedom, P = 0.742 for SNAPPE-II). The multivariate model did not reveal other significant variables. CONCLUSIONS Both severity of illness scores are ascertained during the first 12 h of life and perform similarly. Both can facilitate risk-adjusted comparisons of mortality and quality of care after the first post-natal 12 h. CRIB-II scores have the advantage of being simpler to collect and calculate.
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Affiliation(s)
- Shelley Reid
- RPA Newborn Care, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Faculty of Nursing and Midwifery, University of Sydney, Sydney, New South Wales, Australia
| | - Barbara Bajuk
- NSW Pregnancy and Newborn Services Network (PSN), Sydney, New South Wales, Australia
| | - Kei Lui
- Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia
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- NSW Pregnancy and Newborn Services Network (PSN), Sydney, New South Wales, Australia
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28
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Guenther K, Vach W, Kachel W, Bruder I, Hentschel R. Auditing Neonatal Intensive Care: Is PREM a Good Alternative to CRIB for Mortality Risk Adjustment in Premature Infants? Neonatology 2015; 108:172-8. [PMID: 26278218 DOI: 10.1159/000433414] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 05/18/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Comparing outcomes at different neonatal intensive care units (NICUs) requires adjustment for intrinsic risk. The Clinical Risk Index for Babies (CRIB) is a widely used risk model, but it has been criticized for being affected by therapeutic decisions. The Prematurity Risk Evaluation Measure (PREM) is not supposed to be prone to treatment bias, but has not yet been validated. OBJECTIVES We aimed to validate the PREM, compare its accuracy to that of the original and modified versions of the CRIB and CRIB-II, and examine the congruence of risk categorization. METHODS Very-low-birth-weight (VLBW) infants with a gestational age (GA) <33 weeks, who were admitted to NICUs in Baden-Württemberg from 2003 to 2008, were identified from the German neonatal quality assurance program. CRIB, CRIB-II and PREM scores were calculated and modified. Omitting variables that directly reflected therapeutic decisions [the applied fraction of inspired oxygen (FiO2)] or that may have been prone to early-treatment bias (base excess and temperature), non-NICU-therapy-influenced scores were obtained. Score performance was assessed by the area under their ROC curve (AUC). RESULTS The CRIB showed the largest AUC (0.89), which dropped significantly (to 0.85) after omitting the FiO2. The PREM birth condition model, PREM(bcm) (AUC 0.86), and the PREM birth model, PREM(bm) (AUC 0.82), also demonstrated good discrimination. PREM(bm) was superior to other non-therapy-affected scores and to GA, particularly in infants with <750 g birth weight. Congruence of risk categorization was low, especially among higher-risk cases. CONCLUSIONS The CRIB score had the largest AUC, resulting from its inclusion of FiO2. PREM(bm), as the most accurate score among those unaffected by early treatment, seems to be a good alternative for strict risk adjustment in NICU auditing. It could be useful to combine scores.
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Affiliation(s)
- Kilian Guenther
- Division of Neonatology/Intensive Care Medicine, Center for Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany
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Castro ECMD, Leite ÁJM, Almeida MFBD, Guinsburg R. Perinatal factors associated with early neonatal deaths in very low birth weight preterm infants in Northeast Brazil. BMC Pediatr 2014; 14:312. [PMID: 25528150 PMCID: PMC4308919 DOI: 10.1186/s12887-014-0312-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 12/11/2014] [Indexed: 11/10/2022] Open
Abstract
Background In Brazil, the prevalence of prematurity has increased in recent years and it is a major cause of death in the neonatal period. Therefore, this study aims at assessing perinatal factors associated with early neonatal deaths in very low birth weight preterm infants born in a region of Brazil with low Human Development Index. Methods Prospective cohort study of inborns with gestational age 230/7-316/7 weeks and birthweight 500-1499 g without malformations in 19 public reference hospitals of the state capitals of Brazil’s Northeast Region. Perinatal variables associated with early neonatal death were determined by Cox regression analysis. Result Among 627 neonates, 179 (29%) died with 0–6 days after birth. Early death was associated to: absence of antenatal steroids (HR 1.59; 95% CI 1.11-2.27), multiple gestation (1.95; 1.28-3.00), male sex (2.01; 1.40-2.86), 5th minute Apgar <7 (2.93; 2.03-4.21), birthweight <1000 g (2.58; 1.70-3.88), gestational age <28 weeks (2.07; 1.42-3.02), use of surfactant (1.65; 1.04-2.59), and non-use of a pain scale (1.89; 1.24-2.89). Conclusion Biological variables and factors related to the quality of perinatal care were associated with the high chance of early death of preterm infants born in reference hospitals of Northeast Brazil.
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Affiliation(s)
- Eveline Campos Monteiro de Castro
- Neonatal Unit of Maternidade Escola Assis Chateaubriand, Universidade Federal do Ceará, 3678 aptº 1600 - Meireles, CEP: 60165-121, Fortaleza, CE, Brazil.
| | | | | | - Ruth Guinsburg
- Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil.
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Shah PS, Lee SK, Lui K, Sjörs G, Mori R, Reichman B, Håkansson S, Feliciano LS, Modi N, Adams M, Darlow B, Fujimura M, Kusuda S, Haslam R, Mirea L. The International Network for Evaluating Outcomes of very low birth weight, very preterm neonates (iNeo): a protocol for collaborative comparisons of international health services for quality improvement in neonatal care. BMC Pediatr 2014; 14:110. [PMID: 24758585 PMCID: PMC4021416 DOI: 10.1186/1471-2431-14-110] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 03/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The International Network for Evaluating Outcomes in Neonates (iNeo) is a collaboration of population-based national neonatal networks including Australia and New Zealand, Canada, Israel, Japan, Spain, Sweden, Switzerland, and the UK. The aim of iNeo is to provide a platform for comparative evaluation of outcomes of very preterm and very low birth weight neonates at the national, site, and individual level to generate evidence for improvement of outcomes in these infants. METHODS/DESIGN Individual-level data from each iNeo network will be used for comparative analysis of neonatal outcomes between networks. Variations in outcomes will be identified and disseminated to generate hypotheses regarding factors impacting outcome variation. Detailed information on physical and environmental factors, human and resource factors, and processes of care will be collected from network sites, and tested for association with neonatal outcomes. Subsequently, changes in identified practices that may influence the variations in outcomes will be implemented and evaluated using quality improvement methods. DISCUSSION The evidence obtained using the iNeo platform will enable clinical teams from member networks to identify, implement, and evaluate practice and service provision changes aimed at improving the care and outcomes of very low birth weight and very preterm infants within their respective countries. The knowledge generated will be available worldwide with a likely global impact.
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Affiliation(s)
- Prakesh S Shah
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, Ontario M5G 1X6, Canada
| | - Shoo K Lee
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, Ontario M5G 1X6, Canada
| | - Kei Lui
- Australia and New Zealand Neonatal Network, Royal Hospital for Women, Level 2, McNevin Dickson Building, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Gunnar Sjörs
- Swedish Neonatal Quality Register, Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden
| | - Rintaro Mori
- Neonatal Research Network Japan, Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Brian Reichman
- Israeli Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer 52621, Israel
| | - Stellan Håkansson
- Swedish Neonatal Quality Register, Department of Pediatrics, Umea University Hospital, SE-901 85 Umeå, Sweden
| | - Laura San Feliciano
- Spanish Neonatal Network, Unidad Neonatal Barakaldo, Plaza de cruces s/n, 5ª Planta, Unidad Neonatal, Barakaldo 48903, (Bizkaia), Spain
| | - Neena Modi
- UK Neonatal Collaborative, Imperial College London, Chelsea and Westminster Hospital Campus, London SW10 9NH, UK
| | - Mark Adams
- Swiss Neonatal Network, Division of Neonatology, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091 Zürich, Switzerland
| | - Brian Darlow
- Australia and New Zealand Neonatal Network, University of Otago, Christchurch, 2 Riccarton Avenue, PO Box 4345, Christchurch 8140, New Zealand
| | - Masanori Fujimura
- Neonatal Research Network Japan, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan
| | - Satoshi Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women’s Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Ross Haslam
- Australia and New Zealand Neonatal Network, Women’s and Children’s Hospital, Adelaide, Level 2, McNevin Dickson Building, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Lucia Mirea
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, Ontario M5G 1X6, Canada
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Ravelli ACJ, Schaaf JM, Mol BWJ, Tamminga P, Eskes M, van der Post JAM, Abu-Hanna A. Antenatal prediction of neonatal mortality in very premature infants. Eur J Obstet Gynecol Reprod Biol 2014; 176:126-31. [PMID: 24666798 DOI: 10.1016/j.ejogrb.2014.02.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 06/29/2013] [Accepted: 02/18/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To develop a prognostic model for antenatal prediction of neonatal mortality in infants threatening to be born very preterm (<32 weeks). STUDY DESIGN Nationwide cohort study in The Netherlands between 1999 and 2007. We studied 8500 singletons born between 25(+0) and 31(+6) weeks of gestation where fetus was alive at birth without congenital anomalies. We developed a multiple logistic regression model to estimate the risk of neonatal mortality within 28 days after birth, based on characteristics that are known before birth. We used bootstrapping techniques for internal validation. Discrimination (AUC), accuracy (Brier score) and calibration (graph, c-statistics) were used to assess the model's predictive performance. RESULTS Neonatal mortality occurred in 766 (90 per 1000) live births. The final model consisted of seven variables. Predictors were low gestational age, no antental corticosteroids, male gender, maternal age ≥35 years, Caucasian ethnicity, non-cephalic presentation and non-3rd level of hospital. The predicted probabilities ranged from 0.003 to 0.697 (IQR 0.02-0.11). The model had an AUC of 0.83, the Brier score was 0.065. The calibration graph showed good calibration, and the test for the Hosmer Lemeshow c-statistic showed no lack of fit (p=0.43). CONCLUSIONS Neonatal mortality can be predicted for very preterm births based on the antenatal factors gestational age, antental corticosteroids, fetal gender, maternal age, ethnicity, presentation and level of hospital. This model can be helpful in antenatal counseling.
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Affiliation(s)
- Anita C J Ravelli
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands.
| | - Jelle M Schaaf
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands; Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
| | - Pieter Tamminga
- Department of Neonatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Martine Eskes
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Joris A M van der Post
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
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Silva CFD, Leite AJM, Almeida NMGSD, Leon ACMPD, Olofin I. Fatores associados ao obito neonatal de recem-nascidos de alto risco: estudo multicentrico em Unidades Neonatais de Alto Risco no Nordeste brasileiro. CAD SAUDE PUBLICA 2014; 30:355-68. [DOI: 10.1590/0102-311x00050013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 08/22/2013] [Indexed: 11/22/2022] Open
Abstract
Este estudo pretendeu determinar os fatores associados à mortalidade intra-hospitalar, utilizando como variáveis explicativas as características individuais da mãe, da assistência ao pré-natal, parto e período neonatal e dos recém-nascidos internados em Unidades Neonatais de Alto Risco (UTIN) integrantes da Rede Norte-Nordeste de Saúde Perinatal no Nordeste do Brasil. Foi realizado estudo longitudinal, multicêntrico de base hospitalar. A população do estudo compreendeu 3.623 nascidos vivos internados em 34 UTIN. Após o ajuste para os três níveis hierárquicos do modelo de determinação do óbito em UTIN até o 27 o dia de vida, associaram-se: tipo de parto – cesariana (OR = 0,72; IC95%: 0,56-0,95); não uso de corticoide antenatal (OR = 1,51; IC95%: 1,01-2,25); pré-eclâmpsia (OR = 0,73; IC95%: 0,56-0,95); oligodramnia (OR = 1,57; IC95%: 1,17-2,10); peso ao nascer < 2.500g (OR = 1,40; IC95%: 1,03-1,90); escore de Apgar 5 o minuto < 7 (OR = 2,63; IC95%: 2,21-3,14); uso de tubo endotraqueal (OR = 1,95; IC95%: 1,31-2,91); não uso de surfactante (OR = 0,54; IC95%: 0,43-0,69). O óbito em UTIN é determinado pelas condições assistenciais à gestação, parto e recém-nato.
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Sacco Casamassima MG, Salazar JH, Papandria D, Fackler J, Chrouser K, Boss EF, Abdullah F. Use of risk stratification indices to predict mortality in critically ill children. Eur J Pediatr 2014; 173:1-13. [PMID: 23525543 DOI: 10.1007/s00431-013-1987-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 03/06/2013] [Indexed: 10/27/2022]
Abstract
UNLABELLED The complexity and high cost of neonatal and pediatric intensive care has generated increasing interest in developing measures to quantify the severity of patient illness. While these indices may help improve health care quality and benchmark mortality across hospitals, comprehensive understanding of the purpose and the factors that influenced the performance of risk stratification indices is important so that they can be compared fairly and used most appropriately. In this review, we examined 19 indices of risk stratification used to predict mortality in critically ill children and critically analyzed their design, limitations, and purposes. Some pediatric and neonatal models appear well-suited for institutional benchmarking purposes, with relatively brief data acquisition times, limited potential for treatment-related bias, and reliance on diagnostic variables that permit adjustment for case mix. Other models are more suitable for use in clinical trials, as they rely on physiologic variables collected over an extended period, to better capture the interaction between organ systems function and specific therapeutic interventions in acutely ill patients. Irrespective of their clinical or research applications, risk stratification indices must be periodically recalibrated to adjust for changes in clinical practice in order to remain valid outcome predictors in pediatric intensive care units. Longitudinal auditing, education, training, and guidelines development are also critical to ensure fidelity and reproducibility in data reporting. CONCLUSION Risk stratification indices are valid tools to describe intensive care unit population and explain differences in mortality.
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Affiliation(s)
- Maria Grazia Sacco Casamassima
- Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
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Cardoso RCA, Flores PVG, Vieira CL, Bloch KV, Pinheiro RS, Fonseca SC, Coeli CM. Infant mortality in a very low birth weight cohort from a public hospital in Rio de Janeiro, RJ, Brazil. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2013. [DOI: 10.1590/s1519-38292013000300005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
OBJECTIVES: to evaluate infant mortality in very low birth weight newborns from a public hospital in Rio de Janeiro, Brazil (2002-2006). METHODS: a retrospective cohort study was performed using the probabilistic linkage method to identify infant mortality. Mortality proportions were calculated according to birth weight intervals and period of death. The Kaplan-Meier method was used to estimate overall cumulative survival probability. The association between maternal schooling and survival of very low birth weight infants was evaluated by means of Cox proportional hazard models adjusted for: prenatal care, birth weight, and gestational age. RESULTS: the study included 782 very low birth weight newborns. Of these, (28.6%) died before one year of age. Neonatal mortality was 19.5%, and earlyneonatal mortality was 14.9%. Mortality was highest in the lowest weight group (71.6%). Newborns whose mothers had less than four years of schooling had 2.5 times higher risk of death than those whose mothers had eight years of schooling or more, even after adjusting for intermediate factors. CONCLUSIONS: the results showed higher mortality among very low birth weight infants. Low schooling was an independent predictor of infant death in this low-income population sample.
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Soll RF, Edwards EM, Badger GJ, Kenny MJ, Morrow KA, Buzas JS, Horbar JD. Obstetric and neonatal care practices for infants 501 to 1500 g from 2000 to 2009. Pediatrics 2013; 132:222-8. [PMID: 23858426 DOI: 10.1542/peds.2013-0501] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To identify changes in clinical practices for infants with birth weights of 501 to 1500 g born from 2000 to 2009. METHODS We used prospectively collected registry data for 355,806 infants born from 2000 to 2009 and cared for at 669 North American hospitals in the Vermont Oxford Network. Main outcome measures included obstetric and neonatal practices, including cesarean delivery, antenatal steroids, delivery room interventions, respiratory practices, neuroimaging, retinal exams, and feeding at discharge. RESULTS Significant changes in many obstetric, delivery room, and neonatal practices occurred from 2000 to 2009. Use of surfactant treatment in the delivery room increased overall (adjusted difference [AD] 17.0%; 95% confidence interval [CI] 16.4% to 17.6%), as did less-invasive methods of respiratory support, such as nasal continuous positive airway pressure (AD 9.9%; 95% CI 9.1% to 10.6%). Use of any ventilation (AD -7.5%; 95% CI -8.0% to -6.9%) and steroids for chronic lung disease (AD -15.3%; 95% CI -15.8% to -14.8%) decreased significantly overall. Most of the changes in respiratory care were observed within each of 4 birth weight strata (501-750 g, 751-1000 g, 1001-1250 g, 1251-1500 g). CONCLUSIONS Many obstetric and neonatal care practices used in the management of infants 501 to 1500 g changed between 2000 and 2009. In particular, less-invasive approaches to respiratory support increased.
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Affiliation(s)
- Roger F Soll
- Department of Pediatrics, University of Vermont, Burlington, Vermont 05401, USA.
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Ciccone MM, Scicchitano P, Salerno C, Gesualdo M, Fornarelli F, Zito A, Filippucci L, Riccardi R, Cortese F, Pini F, Angrisani L, Di Mauro A, Schettini F, Laforgia N. Aorta structural alterations in term neonates: the role of birth and maternal characteristics. BIOMED RESEARCH INTERNATIONAL 2013. [PMID: 23984364 DOI: 10.1155.2013/459168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIM To evaluate the influence of selected maternal and neonatal characteristics on aorta walls in term, appropriately grown-for-gestational age newborns. METHODS Age, parity, previous abortions, weight, height, body mass index before and after delivery, smoking, and history of hypertension, of diabetes, of cardiovascular diseases, and of dyslipidemia were all assessed in seventy mothers. They delivered 34 males and 36 females healthy term newborns who underwent ultrasound evaluation of the anteroposterior infrarenal abdominal aorta diameter (APAO), biochemical profile (glucose, insulin, total cholesterol, HDL and LDL cholesterol, triglycerides, fibrinogen, and D-dimers homeostasis model assessment [HOMAIR]index), and biometric parameters. RESULTS APAO was related to newborn length (r = +0.36; P = 0.001), head circumference (r = +0.37; P = 0.001), gestational age (r = +0.40, P = 0.0005), HOMA index (r = +0.24; P = 0.04), and D-dimers (r = +0.33, P = 0.004). Smoke influenced APAO values (odds ratio: 1.80; confidence interval 95%: 1.05-3.30), as well as diabetes during pregnancy (r = +0.42, P = 0.0002). Maternal height influenced neonatal APAO (r = +0.47, P = 0.00003). Multiple regression analysis outlined neonatal D-dimers as still significantly related to neonatal APAO values. CONCLUSIONS Many maternal and neonatal characteristics could influence aorta structures. Neonatal D-dimers are independently related to APAO.
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Affiliation(s)
- Marco Matteo Ciccone
- Cardiovascular Disease Section, Department of Emergency and Organ Transplantation, University of Bari, Piazza G Cesare 11, 70124 Bari, Italy.
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Aorta structural alterations in term neonates: the role of birth and maternal characteristics. BIOMED RESEARCH INTERNATIONAL 2013; 2013:459168. [PMID: 23984364 PMCID: PMC3741912 DOI: 10.1155/2013/459168] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 06/28/2013] [Accepted: 07/08/2013] [Indexed: 12/21/2022]
Abstract
Aim. To evaluate the influence of selected maternal and neonatal characteristics on aorta walls in term, appropriately grown-for-gestational age newborns.
Methods. Age, parity, previous abortions, weight, height, body mass index before and after delivery, smoking, and history of hypertension, of diabetes, of cardiovascular diseases, and of dyslipidemia were all assessed in seventy mothers. They delivered 34 males and 36 females healthy term newborns who underwent ultrasound evaluation of the anteroposterior infrarenal abdominal aorta diameter (APAO), biochemical profile (glucose, insulin, total cholesterol, HDL and LDL cholesterol, triglycerides, fibrinogen, and D-dimers homeostasis model assessment [HOMAIR]index), and biometric parameters. Results. APAO was related to newborn length (r = +0.36; P = 0.001), head circumference (r = +0.37; P = 0.001), gestational age (r = +0.40, P = 0.0005), HOMA index (r = +0.24; P = 0.04), and D-dimers (r = +0.33, P = 0.004). Smoke influenced APAO values (odds ratio: 1.80; confidence interval 95%: 1.05–3.30), as well as diabetes during pregnancy (r = +0.42, P = 0.0002). Maternal height influenced neonatal APAO (r = +0.47, P = 0.00003). Multiple regression analysis outlined neonatal D-dimers as still significantly related to neonatal APAO values. Conclusions. Many maternal and neonatal characteristics could influence aorta structures. Neonatal D-dimers are independently related to APAO.
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De Jesus LC, Pappas A, Shankaran S, Li L, Das A, Bell EF, Stoll BJ, Laptook AR, Walsh MC, Hale EC, Newman NS, Bara R, Higgins RD. Outcomes of small for gestational age infants born at <27 weeks' gestation. J Pediatr 2013; 163:55-60.e1-3. [PMID: 23415614 PMCID: PMC3947828 DOI: 10.1016/j.jpeds.2012.12.097] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 12/13/2012] [Accepted: 12/28/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine whether small for gestational age (SGA) infants born at <27 weeks gestational age (GA) are at increased risk for mortality, morbidity, and growth and neurodevelopmental impairment at 18-22 months corrected age. STUDY DESIGN This was a retrospective cohort study from National Institute of Child Health and Human Development Neonatal Research Network's Generic Database and Follow-Up Studies. Infants born at <27 weeks GA between January 2006 and July 2008 were included. SGA was defined as birth weight <10th percentile for GA based on Olsen growth curves. Infants with birth weight ≥ 10th percentile for GA were classified as non-SGA. Maternal and infant characteristics, neonatal outcomes, and neurodevelopmental data were compared in SGA and non-SGA infants. Neurodevelopmental impairment was defined as any of the following: cognitive score <70 on the Bayley Scales of Infant Development III, moderate or severe cerebral palsy, bilateral hearing loss (with and without amplification), or blindness (bilateral vision <20/200). Logistic regression analysis was applied to evaluate the associations between SGA status and death or neurodevelopmental impairment. RESULTS The SGA group comprised 385 infants; the non-SGA group, 2586 infants. Compared with mothers of non-SGA infants, mothers of SGA infants were more likely to have a high school education, prenatal care, cesarean delivery, pregnancy-induced hypertension, and antenatal corticosteroid exposure. Compared with non-SGA infants, SGA infants had higher mortality and were more likely to have postnatal growth failure, prolonged mechanical ventilation, and postnatal steroid use. SGA status was associated with increased risk of death or neurodevelopmental impairment (OR, 3.91; 95% CI, 2.91-5.25; P < .001). CONCLUSION SGA status in infants born at <27 weeks GA is associated with an increased likelihood of postnatal steroid use, mortality, growth failure, and neurodevelopmental impairment at 18-22 months corrected age.
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Affiliation(s)
| | - Athina Pappas
- Department of Pediatrics, Wayne State University, Detroit, MI
| | | | - Lei Li
- Statistics and Epidemiology Unit, RTI International, Research Triangle Park, NC
| | - Abhik Das
- Statistics and Epidemiology Unit, RTI International, Research Triangle Park, NC
| | - Edward F. Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Barbara J. Stoll
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | | | - Michele C. Walsh
- Department of Pediatrics, Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, OH
| | - Ellen C. Hale
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Nancy S. Newman
- Department of Pediatrics, Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, OH
| | - Rebecca Bara
- Department of Pediatrics, Wayne State University, Detroit, MI
| | - Rosemary D. Higgins
- Eunice Kennedy Shriver National Institute of Health and Human Development, Bethesda, MD
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Corchia C, Ferrante P, Da Frè M, Di Lallo D, Gagliardi L, Carnielli V, Miniaci S, Piga S, Macagno F, Cuttini M. Cause-specific mortality of very preterm infants and antenatal events. J Pediatr 2013; 162:1125-32, 1132.e1-4. [PMID: 23337093 DOI: 10.1016/j.jpeds.2012.11.093] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 09/24/2012] [Accepted: 11/09/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess the relationship between antenatal factors and cause-specific risk of death in a large area-based cohort of very preterm infants. STUDY DESIGN The ACTION (Accesso alle Cure e Terapie Intensive Ostetriche e Neonatali) study recruited during an 18-month period all infants 22-31 weeks' gestational age admitted to neonatal care in 6 Italian regions (n=3040). We analyzed the data of 2974 babies without lethal or acutely life-threatening malformations. Cause-specific risks of death adjusted for competing causes were calculated, and region-stratified multiple Cox regression analyses were used to study the association between cause-specific mortality and infants' characteristics, pregnancy complications, antenatal steroids, and place of birth. RESULTS Deaths attributable to respiratory problems and intraventricular hemorrhage prevailed in the first 2 weeks of life, and those attributable to infections and gastrointestinal diseases afterwards. Antepartum hemorrhage was associated with respiratory deaths (hazard ratio [HR] 1.6, 95% CI 1.1-2.4), and maternal infection with deaths attributable to asphyxia (HR 32.5, 95% CI 4.1-259.4) and to respiratory problems (HR 2.8, 95% CI 1.6-5.2). Preterm premature rupture of membranes increased the likelihood of deaths due to neonatal infection (HR 1.8, 95% CI 1.0-3.1), and preterm labor/contractions of those due to respiratory (HR 1.5, 95% CI 1.1-2.0) and gastrointestinal diseases (HR 5.8, 95% CI 2.1-16.3). In addition, a birth weight z-score<-1 was associated with increasing hazards of death resulting from asphyxia, late infections, respiratory, and gastrointestinal diseases. CONCLUSIONS Different complications of pregnancy lead to different cause-specific mortality patterns in very preterm infants.
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Affiliation(s)
- Carlo Corchia
- International Center on Birth Defects and Prematurity, Rome, Italy
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Manktelow BN, Seaton SE, Field DJ, Draper ES. Population-based estimates of in-unit survival for very preterm infants. Pediatrics 2013; 131:e425-32. [PMID: 23319523 DOI: 10.1542/peds.2012-2189] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Estimates of the probability of survival of very preterm infants admitted to NICU care are vital for counseling parents, informing care, and planning services. In 1999, easy-to-use charts of survival according to gestation, birth weight, and gender were published in the United Kingdom. These charts are widely used in clinical care and for benchmarking survival, and they form the core of the Clinical Risk Index for Babies II score. Since their publication, the survival of preterm infants has improved, and the charts therefore need updating. METHODS A logistic model was fitted with gestational age, birth weight, and gender. Nonlinear functions were estimated by using fractional polynomials. Bootstrap methods were used to assess the internal validity of the final model. The final model was assessed both overall and for subgroups of infants by using Farrington's statistic, the c-statistic, Cox regression coefficients, and the Brier score. RESULTS A total of 2995 white singleton infants born at 23(+0) to 32(+6) weeks' gestation in 2008 through 2010 were identified; 2751 (91.9%) infants survived to discharge. A prediction model was estimated and good model fit confirmed (area under receiver-operating characteristics curve = 0.86). Survival ranged from 27.7% (23 weeks) to 99.1% (32 weeks) for boys and from 34.5% (23 weeks) to 99.3% (32 weeks) for girls. Updated charts were produced showing estimated survival according to gestation, birth weight and gender, together with contour plots displaying points of equal survival. CONCLUSIONS These survival charts have been updated and will be of use to clinicians, parents, and managers.
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Affiliation(s)
- Bradley N Manktelow
- Department of Health Sciences, University of Leicester, 22-28 Princess Rd West, Leicester LE1 6TP, United Kingdom.
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Maternal preeclampsia is associated with increased risk of necrotizing enterocolitis in preterm infants. Early Hum Dev 2012; 88:893-8. [PMID: 22831636 DOI: 10.1016/j.earlhumdev.2012.07.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 07/03/2012] [Accepted: 07/05/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) is an important cause of mortality and morbidity in preterm infants. AIMS To evaluate the effect of maternal preeclampsia on the development and severity of NEC in premature infants. STUDY DESIGN Prospective observational study in a tertiary neonatal intensive care unit. SUBJECTS The preterm infants of ≤ 37 gestational age who were consecutively hospitalized were enrolled. The study group contained preterm infants born to a preeclamptic mother and the comparison group contained preterm infants born to a normotensive mother. OUTCOME MEASURES The primary outcome was to determine the association between preeclampsia and NEC. RESULTS A total of 88 infants had NEC diagnosis. The incidence of NEC in infants born to preeclamptic mothers (22.9%) was significantly higher compared with those born to normotensive mothers (14.6%). According to NEC stages, NEC was more advanced in preeclamptic mother infants. NEC developed significantly earlier in infants with NEC in the study group. The duration of NEC was also significantly longer in infants born to preeclamptic mothers. In multiple logistic regression model, preeclampsia was found to be predictive of NEC with an odds ratio of 1.74 (95% confidence interval 0.64-0.92). CONCLUSIONS Maternal preeclampsia may be an important risk factor for the development of NEC in premature infants as NEC incidence and severity of NEC were found to be significantly higher in premature infants born to preeclamptic mothers. The onset of NEC was significantly earlier and duration of NEC was longer in these infants.
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Isayama T, Lee SK, Mori R, Kusuda S, Fujimura M, Ye XY, Shah PS. Comparison of mortality and morbidity of very low birth weight infants between Canada and Japan. Pediatrics 2012; 130:e957-65. [PMID: 22966031 DOI: 10.1542/peds.2012-0336] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To compare neonatal outcomes of very low birth weight (VLBW) infants admitted to NICUs participating in the Canadian Neonatal Network and the Neonatal Research Network of Japan. METHODS Secondary analyses of VLBW infants in both national databases between 2006 and 2008 were conducted. The primary outcome was a composite of mortality or any major morbidity defined as severe neurologic injury, bronchopulmonary dysplasia, necrotizing enterocolitis, or severe retinopathy of prematurity at discharge. Secondary outcomes included individual components of primary outcome and late-onset sepsis. Logistic regression adjusting for confounders was performed. RESULTS A total of 5341 infants from the Canadian Neonatal Network and 9812 infants from the Neonatal Research Network of Japan were compared. There were higher rates of maternal hypertension, diabetes mellitus, outborn, prenatal steroid use, and multiples in Canada, whereas cesarean deliveries were higher in Japan. Composite primary outcome was better in Japan in comparison with Canada (adjusted odds ratio [AOR] 0.87, 95% confidence interval [CI] 0.79-0.96). The odds of mortality (AOR 0.40, 95% CI 0.34-0.47), severe neurologic injury (AOR 0.57, 95% CI 0.49-0.66), necrotizing enterocolitis (AOR 0.23, 95% CI 0.19-0.29), and late-onset sepsis (AOR 0.22, 95% CI 0.19-0.25) were lower in Japan; however, the odds of bronchopulmonary dysplasia (AOR 1.24, 95% CI 1.10-1.42) and severe retinopathy of prematurity (AOR 1.98, 95%CI 1.69-2.33) were higher in Japan. CONCLUSIONS Composite outcome of mortality or major morbidity was significantly lower in Japan than Canada for VLBW infants. However, there were significant differences in various individual outcomes identifying areas for improvement for both networks.
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Affiliation(s)
- Tetsuya Isayama
- Department of Paediatrics,University of Toronto, Toronto, Canada
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Pisani F, Copioli C, Turco EC, Sisti L, Cossu G, Seri S. Mortality risk after neonatal seizures in very preterm newborns. J Child Neurol 2012; 27:1264-9. [PMID: 22378670 DOI: 10.1177/0883073811435244] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We analyzed clinical and instrumental data of 403 consecutive newborns with gestational age from 24 to 32 weeks, admitted to the University-Hospital of Parma between January 2000 and December 2007, to evaluate the possible relationship between neonatal mortality and occurrence of neonatal seizures in very preterm newborns. Seventy-four subjects died during hospital stay. Seizures were present in 35 neonates, in whom the mortality rate was 37.1%. Multivariate analysis revealed that birth-weight <1000 g (odds ratio: 4.48; 95% confidence interval: 1.47-13.68; P < .01), cardiopulmonary resuscitation (odds ratio: 5.35; 95% confidence interval: 1.19-23.98; P = .02), and moderately and severely abnormal cerebral ultrasound scan findings (odds ratio: 2.48; 95% confidence interval: 1.02-6.05; P < .04; odds ratio: 9.56; 95% confidence interval: 3.45-26.51; P < .01, respectively) were related to the in-hospital mortality but not the presence of neonatal seizures. Our study suggests that neonatal seizures alone are not an independent risk factor for early death in very preterm newborns.
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Affiliation(s)
- Francesco Pisani
- Child Neuropsychiatric Unit, University of Parma, Via Gramsci 14, Parma, Italy.
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Medlock S, Ravelli ACJ, Tamminga P, Mol BWM, Abu-Hanna A. Prediction of mortality in very premature infants: a systematic review of prediction models. PLoS One 2011; 6:e23441. [PMID: 21931598 PMCID: PMC3169543 DOI: 10.1371/journal.pone.0023441] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 07/18/2011] [Indexed: 11/25/2022] Open
Abstract
Context Being born very preterm is associated with elevated risk for neonatal mortality. The aim of this review is to give an overview of prediction models for mortality in very premature infants, assess their quality, identify important predictor variables, and provide recommendations for development of future models. Methods Studies were included which reported the predictive performance of a model for mortality in a very preterm or very low birth weight population, and classified as development, validation, or impact studies. For each development study, we recorded the population, variables, aim, predictive performance of the model, and the number of times each model had been validated. Reporting quality criteria and minimum methodological criteria were established and assessed for development studies. Results We identified 41 development studies and 18 validation studies. In addition to gestational age and birth weight, eight variables frequently predicted survival: being of average size for gestational age, female gender, non-white ethnicity, absence of serious congenital malformations, use of antenatal steroids, higher 5-minute Apgar score, normal temperature on admission, and better respiratory status. Twelve studies met our methodological criteria, three of which have been externally validated. Low reporting scores were seen in reporting of performance measures, internal and external validation, and handling of missing data. Conclusions Multivariate models can predict mortality better than birth weight or gestational age alone in very preterm infants. There are validated prediction models for classification and case-mix adjustment. Additional research is needed in validation and impact studies of existing models, and in prediction of mortality in the clinically important subgroup of infants where age and weight alone give only an equivocal prognosis.
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Affiliation(s)
- Stephanie Medlock
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Ozkan H, Cetinkaya M, Koksal N, Ozmen A, Yıldız M. Maternal preeclampsia is associated with an increased risk of retinopathy of prematurity. J Perinat Med 2011; 39:523-7. [PMID: 21878037 DOI: 10.1515/jpm.2011.071] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the effect of maternal preeclampsia on development and severity of retinopathy of prematurity (ROP) in preterm infants. METHODS This prospective study consisted of two groups: the study group, which is composed of preterm infants (≤32 weeks) born to a mother with preeclampsia, and the comparison group, which is composed of preterm infants (≤32 gestational age) born to normotensive mothers. We used the International Classification of Retinopathy of Prematurity Revisited for classifying ROP. The first eye examination was performed at postnatal age of 4 weeks. RESULTS A total of 385 infants were included in the study. ROP was diagnosed in 109 infants (28%). The incidence of ROP in infants born to preeclamptic mothers (40.5%) was significantly higher compared with those born to normotensive mothers (22.4%) (P<0.05). The number of infants with stage 1, 2, and 3 ROP was significantly higher in infants born to preeclamptic mothers compared with the control group (P<0.05). In multiple logistic regression model, preeclampsia was found to predict ROP (odds ratio 1.78, 95% confidence interval 0.66-1.90). CONCLUSION Maternal preeclampsia was found to be associated with increased ROP development risk in premature infants. ROP was also more severe in infants born to pre-eclamptic mothers. The role of maternal preeclampsia in the occurrence and severity of ROP remains to be elucidated.
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Affiliation(s)
- Hilal Ozkan
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Uludag University, Bursa, Turkey
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Abstract
Development of the kidney can be altered in utero in response to a suboptimal environment. The intrarenal factors that have been most well characterized as being sensitive to programming events are kidney mass/nephron endowment, the renin-angiotensin system, tubular sodium handling, and the renal sympathetic nerves. Newborns that have been subjected to an adverse intrauterine environment may thus begin life at a distinct disadvantage, in terms of renal function, at a time when the kidney must take over the primary role for extracellular fluid homeostasis from the placenta. A poor beginning, causing renal programming, has been linked to increased risk of hypertension and renal disease in adulthood. However, although a cause for concern, increasingly, evidence demonstrates that renal programming is not a fait accompli in terms of future cardiovascular and renal disease. A greater understanding of postnatal renal maturation and the impact of secondary factors (genes, sex, diet, stress, and disease) on this process is required to predict which babies are at risk of increased cardiovascular and renal disease as adults and to be able to devise preventative measures.
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Affiliation(s)
- Michelle M Kett
- Department of Physiology, Monash University, Clayton, Victoria, Australia
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Çetinkaya M, Özkan H, Köksal N, Karali Z, Özgür T. Neonatal outcomes of premature infants born to preeclamptic mothers. J Matern Fetal Neonatal Med 2010. [DOI: 10.3109/14767050903184173] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lee SK, Aziz K, Singhal N, Cronin CM, James A, Lee DSC, Matthew D, Ohlsson A, Sankaran K, Seshia M, Synnes A, Walker R, Whyte R, Langley J, MacNab YC, Stevens B, von Dadelszen P. Improving the quality of care for infants: a cluster randomized controlled trial. CMAJ 2009; 181:469-76. [PMID: 19667033 PMCID: PMC2761437 DOI: 10.1503/cmaj.081727] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND We developed and tested a new method, called the Evidence-based Practice for Improving Quality method, for continuous quality improvement. METHODS We used cluster randomization to assign 6 neonatal intensive care units (ICUs) to reduce nosocomial infection (infection group) and 6 ICUs to reduce bronchopulmonary dysplasia (pulmonary group). We included all infants born at 32 or fewer weeks gestation. We collected baseline data for 1 year. Practice change interventions were implemented using rapid-change cycles for 2 years. RESULTS The difference in incidence trends (slopes of trend lines) between the ICUs in the infection and pulmonary groups was - 0.0020 (95% confidence interval [CI] - 0.0007 to 0.0004) for nosocomial infection and - 0.0006 (95% CI - 0.0011 to - 0.0001) for bronchopulmonary dysplasia. INTERPRETATION The results suggest that the Evidence-based Practice for Improving Quality method reduced bronchopulmonary dysplasia in the neonatal ICU and that it may reduce nosocomial infection.
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Affiliation(s)
- Shoo K Lee
- Departments of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
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Donoghue DA, Henderson-Smart DJ. The establishment of the Australian and New Zealand Neonatal Network. J Paediatr Child Health 2009; 45:400-4. [PMID: 19712174 DOI: 10.1111/j.1440-1754.2009.01527.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Australian and New Zealand Neonatal Network was established in 1994 to monitor high-risk newborns admitted for care. Uniquely, all units in both countries have participated since inception, making it integral to the care of babies. The network's objectives include auditing care, publishing aggregated results annually, providing feedback to units, monitoring technologies and developing clinical indicators. Networking provides a forum for clinicians and a consortium of knowledge and advice. It facilitates collaborative research and clinical groups, producing projects from observational studies to randomised controlled trials. Members take a major role in reviewing the evidence for care and ensuring its effective use in clinical practice.
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Affiliation(s)
- Deborah A Donoghue
- Northern Rivers University Department of Rural Health, Lismore, NSW 2480, Australia.
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50
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Abstract
OBJETIVO: verificar o desempenho de habilidades do desenvolvimento linguístico, cognitivo, motor, de autocuidados e socialização em crianças prematuras. MÉTODOS: participaram 30 crianças nascidas prematuras, de ambos os sexos de seis a 24 meses. Os procedimentos de avaliação constaram de uma entrevista de anamnese e da aplicação do Inventário Portage Operacionalizado (IPO) (Wilhiams & Aiello, 2001). As crianças foram divididas em dois grupos, conforme a faixa etária, para análise estatística dos dados, considerando as idades de seis a 11 meses e de 12 a 24 meses. A análise dos dados foi realizada por meio da aplicação do teste Manny-Whitney comparando os valores obtidos no grupo de crianças prematuras com escores previstos para crianças típicas. RESULTADOS: os resultados indicam que a área mais defasada do grupo na faixa etária de seis a 12 meses foi à linguística e autocuidados e na faixa etária de 12 a 24 meses as áreas mais defasadas foram linguística, cognitiva e de autocuidados. CONCLUSÃO: ressalta-se a necessidade de um acompanhamento rigoroso de recém-nascidos prematuros, por meio do desenvolvimento de programas de acompanhamento e por uma equipe multidisciplinar para promover a detecção e intervenção precoce, minimizando assim o impacto de problemas no desenvolvimento global destas crianças.
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