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Thatrimontrichai A, Phatigomet M, Maneenil G, Dissaneevate S, Janjindamai W. Risk Factors for Mortality or Major Morbidities of Very Preterm Infants: A Study from Thailand. Am J Perinatol 2024; 41:1379-1387. [PMID: 36669757 DOI: 10.1055/a-2016-7568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Very preterm neonates have high rates of composite outcomes featuring mortality and major morbidities. If the modifiable risk factors could be identified, perhaps the rates could be decreased especially in resource-limited settings. STUDY DESIGN We performed a prospective study in a Thai neonatal intensive care unit to identify the risk factors of composite outcomes between 2014 and 2021. The inclusion criterion was neonates who were born in our hospital at a gestational age (GA) of less than 32 weeks. The exclusion criteria were neonates who died in the delivery room or had major congenital anomalies. The composite outcomes were analyzed by multivariable logistic regression with adjusted odds ratios (aORs) and a 95% confidence interval (CI). RESULTS Over the 8-year study period, 555 very preterm inborn neonates without major birth defects were delivered. The composite outcomes were 29.4% (163/555). The medians (interquartile ranges) of GA and birth weights of the neonates were 29 (27-31) weeks and 1,180 (860-1,475) grams, respectively. By multivariable analysis, GA (aOR: 0.65; 95% CI: 0.55-0.77), small for GA (aOR: 4.93; 95% CI: 1.79-13.58), multifetal gestation (aOR: 2.23; 95% CI: 1.12-4.46), intubation within 24 hours (aOR: 5.39; 95% CI: 1.35-21.64), and severe respiratory distress syndrome (aOR: 5.00; 95% CI: 1.05-23.89) were significantly associated with composite outcomes. CONCLUSION Very preterm infants who had a lower GA were small for GA, twins or more, respiratory failure on the first day of life, and severe respiratory distress syndrome were associated with mortality and/or major morbidities. KEY POINTS · In very preterm neonates, the composite outcomes and mortality rate were 29.4 and 12.3%.. · Composite outcomes were associated with lower GA, SGA, multifetal gestation, intubation, and severe RDS.. · Mortality was associated with lower GA or Apgar score at 5 minutes, SGA, and PPHN..
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MESH Headings
- Humans
- Thailand/epidemiology
- Infant, Newborn
- Prospective Studies
- Female
- Male
- Risk Factors
- Intensive Care Units, Neonatal/statistics & numerical data
- Gestational Age
- Logistic Models
- Infant, Extremely Premature
- Respiratory Distress Syndrome, Newborn/mortality
- Respiratory Distress Syndrome, Newborn/epidemiology
- Infant Mortality
- Infant, Premature, Diseases/mortality
- Infant, Premature, Diseases/epidemiology
- Multivariate Analysis
- Infant
- Odds Ratio
- Infant, Small for Gestational Age
- Birth Weight
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Affiliation(s)
- Anucha Thatrimontrichai
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Manapat Phatigomet
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Gunlawadee Maneenil
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Supaporn Dissaneevate
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Waricha Janjindamai
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Yanagisawa T, Nakamura T, Kokubo M. Prognosis of 22- and 23-Gestational-Week-Old Infants at Our Facility: A Retrospective Cohort Study. Am J Perinatol 2024; 41:660-668. [PMID: 35193151 DOI: 10.1055/a-1779-4032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This study aimed to compare inborn infants aged 22 and 23 gestational weeks at our hospital to assess for differences in survival and long-term prognosis. STUDY DESIGN We retrospectively analyzed 22- and 23-gestational-weeks-old infants born in our hospital between January 2011 and December 2018. The prognosis of inborn infants in Japan was also calculated using the Neonatal Research Network of Japan (NRNJ) data during the same period. RESULTS The survival rates at our institution's neonatal intensive care unit discharge, including stillbirth, were 72 and 89% at 22 and 23 gestational weeks, respectively. The mortality rate and neurodevelopmental impairment (NDI) rate at 3 years of age, including stillbirth, were 58 and 32% at 22 and 23 weeks, respectively. Cerebral palsy, mental developmental retardation, visual impairment, and hearing impairment defined NDI. The prognosis at our hospital was better than the average calculated using NRNJ data. Survival rates varied among facilities, and some facilities had survival rates similar to that of our hospital. CONCLUSION The prognosis of 22-gestational-week-old inborn infants was inferior to that of 23 gestational weeks in our institution but was better than previously reported. If aggressive treatment is provided, survival without sequelae can be fully expected even for 22-gestational-week-old infants. KEY POINTS · We examined babies of gestation ages 22 and 23 weeks.. · We examined the survival and neurological prognoses.. · We compared our facility with that in entire Japan..
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Affiliation(s)
| | - Tomohiko Nakamura
- Division of Neonatology, Nagano Children's Hospital, Azumino, Nagano, Japan
- Division of Neonatology, Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Masayo Kokubo
- Division of Neonatology, Nagano Children's Hospital, Azumino, Nagano, Japan
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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Konzett K, Riedl D, Blassnig-Ezeh A, Gang S, Simma B. Outcome in very preterm infants: a population-based study from a regional center in Austria. Front Pediatr 2024; 12:1336469. [PMID: 38370138 PMCID: PMC10873957 DOI: 10.3389/fped.2024.1336469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Aim To determine short-term morbidity and mortality rates in the first state-wide Austrian neonatal cohort and comparison to (inter)national data. Methods Observational, population-based cohort study, analyzing data of preterm infants (<32 + 0 weeks of gestation) born between 2007 and 2020 (n = 501) in an Austrian state who were admitted to the neonatal intensive care unit. Outcome criteria were mortality, neonatal morbidities: bronchopulmonary dysplasia (BPD), severe necrotizing enterocolitis (NEC), severe intraventricular hemorrhage (IVH grades III-IV), severe retinopathy of prematurity (ROP grades III-V) and survival-free of major complications. Results Overall survival rate was 95%, survival free of major complications was 79%. Prevalence for BPD was 11.2%, surgical NEC 4.0%, severe IVH 4.6%, and for severe ROP 2.6%, respectively. In the extremely low gestational age neonates (ELGAN) born <28 weeks of gestation (n = 158), survival was 88% and survival free of major complications 58.8%. Over time, mortality decreased significantly, predominantly driven by the improvement of infants born <28 week of gestation and survival free of major complications improved. Conclusions This study demonstrates a very low mortality rate that decreases over time. Short-term morbidities and survival free of major complications do not differ from (inter)national data in a similar group of very preterm infants. Standard operating procedures, simulation trainings and accordance to international trials may improve patient care and surpass center case loads.
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Affiliation(s)
- Karin Konzett
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - David Riedl
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
- Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Innsbruck, Austria
| | - Anya Blassnig-Ezeh
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Stefanie Gang
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Burkhard Simma
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
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El-Dib I, Farghaly MAA, Saker F, Abu-Shaweesh JM, Alzayyat S, Mohamed MA, Aly H. Chorioamnionitis, Cesarean Deliveries, and Racial Disparities in the USA. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01884-z. [PMID: 38048042 DOI: 10.1007/s40615-023-01884-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/11/2023] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Studies showed disparities in management and outcomes of African American when compared to Caucasian population. The presence of chorioamnionitis may affect the decision to have a cesarean delivery (CD); however, it is not known if such a decision is affected by the mothers' race/ethnicity. OBJECTIVE To assess the interaction between African American race/ethnicity and CD in women with chorioamnionitis. METHODS Utilizing the National Inpatient Sample dataset, we examined the association of CD with chorioamnionitis in the overall population and within Caucasian and African American. Logistic regression models were used to control for confounders. RESULTS The study included 6,648,883 women who delivered 6,925,920 infants. The prevalence of chorioamnionitis was 0.78 and 1.1 in Caucasian and African American, respectively. CD with and without chorioamnionitis was 41.2% and 32.4%, respectively (aOR 1.46 (1.43-1.49), p < 0.001), in Caucasian population and 45.0% and 36.6% in African American population aOR 1.42 (1.37-1.47), p < 0.001. African American population had significantly higher CD after controlling for chorioamnionitis and other confounding variables (aOR of 1.18 (1.17-1.18), p < 0.001). CONCLUSION Chorioamnionitis is associated with increased rate of CD. Ethnic disparities exist in CD rates regardless of the chorioamnionitis status. Such findings warrant further investigation to explore factors associated with this discrepancy.
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Affiliation(s)
- Injy El-Dib
- Cleveland Clinic Children's, 9500 Euclid Avenue #M31, Cleveland, OH, 44195, USA
- School of Biomedical Engineering, Brown University, Providence, RI, USA
| | - Mohsen A A Farghaly
- Cleveland Clinic Children's, 9500 Euclid Avenue #M31, Cleveland, OH, 44195, USA.
| | - Firas Saker
- Cleveland Clinic Children's, 9500 Euclid Avenue #M31, Cleveland, OH, 44195, USA
| | | | - Sarah Alzayyat
- Cleveland Clinic Children's, 9500 Euclid Avenue #M31, Cleveland, OH, 44195, USA
- Faculty of Medicine and Health Sciences, Royal College of Surgeons, Dublin, Ireland
| | - Mohamed A Mohamed
- Cleveland Clinic Children's, 9500 Euclid Avenue #M31, Cleveland, OH, 44195, USA
| | - Hany Aly
- Cleveland Clinic Children's, 9500 Euclid Avenue #M31, Cleveland, OH, 44195, USA
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Pan JJ, Zou YS, Tong ML, Wang J, Zhou XY, Cheng R, Yang Y. Dose pulmonary hemorrhage increase the risk of bronchopulmonary dysplasia in very low birth weight infants? J Matern Fetal Neonatal Med 2023; 36:2206941. [PMID: 37121909 DOI: 10.1080/14767058.2023.2206941] [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: 05/02/2023]
Abstract
OBJECTIVE To evaluate the association between pulmonary hemorrhage and bronchopulmonary dysplasia (BPD) in very low birth weight infants (VLBWIs). METHODS The study participants were all VLBW newborns admitted from January 1, 2019 to December 31, 2021. The BPD subjects finally included were VLBWIs who survived until the diagnosis was established. This study was divided into pulmonary hemorrhage group (PH group, n = 35) and non-pulmonary hemorrhage group (Non-PH group, n = 190). RESULTS By univariate analysis it was found that premature rupture of membranes, tracheal intubation in the delivery room, duration of mechanical ventilation, course of invasive ventilation (≥3 courses), pulmonary surfactant (>1 dose), medically and surgically treated patent ductus arteriosus, grade III-IV RDS, early onset sepsis, BPD and moderate to severe BPD showed significant differences between groups (p < .05). By Multivariate analysis, pulmonary hemorrhage did not increase the risks of BPD and moderate to severe BPD (adjusted OR for BPD = 1.710, 95% CI 0.581-5.039; adjusted OR for moderate to severe BPD = 2.401, 95% CI 0.736-7.834). CONCLUSION It suggests that pulmonary hemorrhage is not associated with the development of BPD and moderate to severe BPD in VLBWIs.
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Affiliation(s)
- Jing-Jing Pan
- Department of Neonates, Jiangsu Provincial Maternal and Child Health Hospital, Nanjing, Jiangsu, P.R. China
| | - Yun-Su Zou
- Department of Neonates, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Mei-Ling Tong
- Department of Child Healthcare, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, P.R. China
| | - Jing Wang
- Department of Child Healthcare, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, P.R. China
| | - Xiao-Yu Zhou
- Department of Neonates, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Rui Cheng
- Department of Neonates, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Yang Yang
- Department of Neonates, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, P.R. China
- Department of Child Healthcare, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, P.R. China
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Shinohara S, Shinohara R, Kojima R, Horiuchi S, Otawa S, Kushima M, Miyake K, Yui H, Ooka T, Akiyama Y, Yokomichi H, Yamagata Z. Obesity as a potential risk factor for stillbirth: The Japan Environment and Children's Study. Prev Med Rep 2023; 35:102391. [PMID: 37662870 PMCID: PMC10474316 DOI: 10.1016/j.pmedr.2023.102391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/05/2023] Open
Abstract
The relationship between high body mass index (BMI) >25 kg/m2 and risk for stillbirth in the Japanese population remains unclear. This study aimed to estimate the impact of maternal obesity on the risk of stillbirth in a Japanese population. This prospective cohort study used data from the Japan Environment and Children's Study, which recruited pregnant individuals between 2011 and 2014. A total of 93,772 fetuses were considered eligible for inclusion in this study. Stillbirth (fetal death before or during labor at ≥22 completed weeks of gestation) rates were compared among four pre-pregnancy BMI groups: underweight (<18.5 kg/m2), reference (18.5 to <25.0 kg/m2), overweight (25.0 to <30.0 kg/m2), and obese (≥30.0 kg/m2). The association between pre-pregnancy BMI and the risk of stillbirth was estimated using multiple logistic regression analyses. The overall stillbirth incidence was 0.33% (305/93,722). Compared with the reference group, the risk of stillbirth was significantly higher in the overweight group (adjusted odds ratio [aOR]: 1.55; 95% confidence interval [CI]: 1.08-2.23) and the obese group (aOR: 2.60; 95% CI: 1.59-4.24). The overall incidence of early stillbirth (i.e., <28 weeks) was 0.17% (155/93,722). Similarly, after adjusting for potential confounding factors, the risk of early stillbirth was significantly higher in the obese group (aOR: 4.33; 95% CI: 2.44-7.70). Increased maternal BMI was associated with an increased risk of stillbirth in the Japanese population. Therefore, counselling women planning for pregnancy on the importance of an appropriate pre-pregnancy BMI to minimize the risk of stillbirth is important.
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Affiliation(s)
- Satoshi Shinohara
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506, Japan
| | - Ryoji Shinohara
- Center for Birth Cohort Studies, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Reiji Kojima
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Sayaka Horiuchi
- Department of Epidemiology and Environmental Medicine, School of Medicine, University of Yamanashi, Chuo, Japan
| | - Sanae Otawa
- Center for Birth Cohort Studies, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Megumi Kushima
- Center for Birth Cohort Studies, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Kunio Miyake
- Department of Epidemiology and Environmental Medicine, School of Medicine, University of Yamanashi, Chuo, Japan
| | - Hideki Yui
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Tadao Ooka
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Yuka Akiyama
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Hiroshi Yokomichi
- Department of Epidemiology and Environmental Medicine, School of Medicine, University of Yamanashi, Chuo, Japan
| | - Zentaro Yamagata
- Center for Birth Cohort Studies, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - the Japan Environment and Children's Study Group
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506, Japan
- Center for Birth Cohort Studies, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
- Department of Epidemiology and Environmental Medicine, School of Medicine, University of Yamanashi, Chuo, Japan
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Davis JW, Seeber CE, Nathan EA, Strunk T, Gill A, Sharp M. Outcomes to 5 years of outborn versus inborn infants <32 weeks in Western Australia: a cohort study of infants born between 2005 and 2018. Arch Dis Child Fetal Neonatal Ed 2023; 108:499-504. [PMID: 36804194 DOI: 10.1136/archdischild-2022-324749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/30/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE We compared mortality and morbidity of inborn versus outborn very preterm infants <32 weeks' gestation in Western Australia (WA) between 2005 and 2018. DESIGN Retrospective cohort study. PATIENTS Infants <32 weeks' gestation who were born in WA. MAIN OUTCOME MEASURES Mortality was assessed as death before discharge home from the tertiary neonatal intensive care unit. Short-term morbidities included combined brain injury (intracranial haemorrhage grade ≥3 and cystic periventricular leukomalacia) and other major neonatal outcomes. Developmental assessments at age 2, 3 and 5 years were evaluated. We performed multivariable logistic regression analysis of outborn status on outcomes, controlling for gestational age, birth weight z-score, sex and multiple birth. RESULTS A total of 4974 infants were born in WA between 22 and 32 weeks' gestation between 2005 and 2018 of which 4237 (89.6%) were inborn and 443 (10.4%) were outborn. Overall mortality to discharge was higher in outborn infants (20.5% (91/443) vs 7.4% (314/4237); adjusted OR (aOR) 2.44, 95% CI 1.60 to 3.70, p<0.001). Outborn infants had higher rates of combined brain injury than those inborn (10.7% (41/384) vs 6.0% (246/4115); aOR 1.98, 95% CI 1.37 to 2.86), p<0.001). No difference in up to 5-year developmental measures was detected. Follow-up data were available for 65% of outborn and 79% of inborn infants. CONCLUSIONS Outborn preterm infants <32 weeks in WA had increased odds of mortality and combined brain injury than those inborn. Developmental outcomes up to 5 years were similar between groups. Loss to follow-up may have impacted the long-term comparison.
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Affiliation(s)
- Jonathan W Davis
- Newborn Emergency Transport Service of Western Australia, Perth Children's Hospital, Nedlands, Western Australia, Australia
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - C E Seeber
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Elizabeth A Nathan
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Tobias Strunk
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Andy Gill
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Mary Sharp
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
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Dincer E, Topçuoğlu S, Karatekin G. Ultrasonography for Determining Endotracheal Tube Tip Position in Very Low Birth Weight Infants. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:437-441. [PMID: 35904138 DOI: 10.1002/jum.16067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/06/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study aims to investigate the feasibility of USG in confirming the endotracheal tube site and compare it with chest X-rays in very low birth weight infants. METHODS A chest X-ray and thorax ultrasonography processes are started as soon as the infant is intubated. Endotracheal tube place is evaluated with ultrasonography and noted, and with chest X-ray and time elapsed in these two processes are noted. The correlation between these two methods was calculated. RESULTS While endotracheal tubes are visualized with 100% success, there was a significant correlation between the measures of endotracheal tube-carina distances (r = .979, P > .001). In addition, ultrasonography was six times faster than chest X-ray interpretation (USG; 4.6 ± 1.8 min vs CXR; 29.6 ± 9.0 min, P < .001). CONCLUSIONS Ultrasonography is a feasible and faster method for determining endotracheal tube place in very low birth weight infants and may prevent radiation exposure in neonatal intensive care units.
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Affiliation(s)
- Emre Dincer
- Neonatology Department, University of Health Sciences, Zeynep Kamil Maternity and Children's Research and Training Hospital, Istanbul, Turkey
| | - Sevilay Topçuoğlu
- Neonatology Department, University of Health Sciences, Zeynep Kamil Maternity and Children's Research and Training Hospital, Istanbul, Turkey
| | - Güner Karatekin
- Neonatology Department, University of Health Sciences, Zeynep Kamil Maternity and Children's Research and Training Hospital, Istanbul, Turkey
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Delaney J, Nunes GDC, Simoneau J, Beltempo M, Malhamé I, Goudie C, Altit G. Thrombocytopenia and neonatal outcomes among extremely premature infants exposed to maternal hypertension. Pediatr Blood Cancer 2023; 70:e30131. [PMID: 36478101 DOI: 10.1002/pbc.30131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/04/2022] [Accepted: 11/12/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are associated with neonatal hematological disturbances, such as thrombocytopenia. The association of HDP to platelet counts in the context of extreme prematurity, to trends of platelet counts during neonatal hospitalization, and to frequency of platelet transfusions remain to be explored. PROCEDURE Retrospective study of infants born at less than 29 weeks born between 2015 and 2019. Platelet counts were collected on initial complete blood count, at 2 weeks, 32 weeks post-menstrual age (PMA), 36 weeks PMA, and closest to discharge. We examined the association between HDP and platelet counts at each time point, frequency of platelet transfusions and intraventricular hemorrhage (IVH) grade 3 or more. RESULTS Total 296 infants were included, 43 exposed to HDP. Infants exposed had lower platelet counts at each time point, as well as a higher prevalence of platelet less than 150 × 109 /L on one of the time points (32% vs. 65%, p < .001). Infants exposed to maternal hypertension were more frequently exposed to platelet transfusions (63% vs. 18%, p < .001). Mixed effect model demonstrated an association between HDP and a lower trend in platelet counts at each time point (β = -94 × 103 /μl, p < .001). Although initial platelet count was associated with severe IVH, it was not associated to exposure to HDP. CONCLUSION Premature infants exposed to HDP have a higher prevalence of thrombocytopenia, increased frequency of platelet transfusion, and an altered trend in platelet counts during neonatal hospitalization.
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Affiliation(s)
- Joanne Delaney
- Department of Pediatrics, Hematology-Oncology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Gabriela De Carvalho Nunes
- Department of Pediatrics, Neonatology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Jessica Simoneau
- Department of Pediatrics, Neonatology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Marc Beltempo
- Department of Pediatrics, Neonatology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Isabelle Malhamé
- Department of Medicine, General Internal Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Catherine Goudie
- Department of Pediatrics, Hematology-Oncology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Gabriel Altit
- Department of Pediatrics, Neonatology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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Inoue T, Nishikubo T, Hirano S, Kamamoto T, Takahashi Y, Kusuda S. Risk factor analyses for intraventricular hemorrhage in preterm infants: A retrospective cohort study. Pediatr Int 2023; 65:e15599. [PMID: 37551656 DOI: 10.1111/ped.15599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/09/2023] [Accepted: 06/07/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Very-low-birthweight (VLBW) infants can experience severe intraventricular hemorrhage (IVH) that can lead to life-long disability by impairing neurodevelopment. The aim of this study was to identify the risk and protective factors for severe IVH in VLBW infants. METHODS A retrospective, cross-sectional review of VLBW infants born at 22-28 weeks' gestation between January 2003 and December 2012 and listed in the Database of Neonatal Research Network in Japan was performed using a statistical model incorporating an odds ratio (OR) and medical center variation as a center variance ratio (CVR). A two-dimensional analysis using a combination of OR and the CVR described evolving measures of a clinical trial (for OR > 1) and standardization (for CVR > 1) concerning a factor of interest. RESULTS The noteworthy significant protective factors were antenatal steroids (ANS) with and without premature rupture of membrane (OR: 0.43, CVR: 1.08, and OR: 0.68, CVR: 1.14, respectively) and the number of neonatal beds (OR: 0.94, CVR: 0.99) and staff nurses per neonatal bed (OR: 0.89, CVR: 0.99). CONCLUSIONS Active promotion of ANS administration and consolidation of perinatal medical centers can mitigate the development of severe IVH in VLBW infants.
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Affiliation(s)
- Takashi Inoue
- Department of Evidence-Based Medicine, Nara Medical University, Kashihara, Japan
| | - Toshiya Nishikubo
- Neonatal Intensive Care, Maternal, Fetal and Neonatal Medical Center, Nara Medical University Hospital, Kashihara, Japan
| | - Shinya Hirano
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Tomoyuki Kamamoto
- Neonatal Intensive Care, Maternal, Fetal and Neonatal Medical Center, Nara Medical University Hospital, Kashihara, Japan
| | | | - Satoshi Kusuda
- Department of Pediatrics, School of Medicine, Kyorin University, Mitaka, Japan
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11
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Jones P, Marchand-Martin L, Desplanches T, Diguisto C, Fresson J, Goffinet F, Dauger S, Ancel PY, Morgan AS. Survival and neurodevelopmental impairment of outborn preterm infants at 5.5 years of age: an EPIPAGE-2 prospective, matched study using multiple imputation. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001619. [PMID: 36645784 PMCID: PMC9756224 DOI: 10.1136/bmjpo-2022-001619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/29/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To determine whether birth outside a level-3 centre (outborn) is associated with a difference in the combined outcome of mortality or moderate-to-severe neurological impairment at 5.5 years of age compared with birth in a level-3 centre (inborn) when antenatal steroids and gestational age (GA) are accounted for. DESIGN Individual matched study nested within a prospective cohort. Each outborn infant was matched using GA and antenatal steroids with a maximum of four inborns. Conditional logistic regression was used to calculate ORs before being adjusted using maternal and birth characteristics. Analyses were carried out after multiple imputation for missing data. SETTING EPIPAGE-2 French national prospective cohort including births up to 34 weeks GA inclusive. PATIENTS Outborn and inborn control infants selected between 24 and 31 weeks GA were followed in the neonatal period and to 2 and 5.5 years. 3335 infants were eligible of whom all 498 outborns and 1235 inborn infants were included-equivalent to 2.5 inborns for each outborn. MAIN OUTCOME MEASURE Survival without moderate-to-severe neurodevelopmental impairment at 5.5 years. RESULTS Chorioamnionitis, pre-eclampsia, caesarian birth and small-for-dates were more frequent among inborns, and spontaneous labour and antepartum haemorrhage among outborns. There was no difference in the main outcome measure at 5.5 years of age (adjusted OR 1.09, 95% CI 0.82 to 1.44); sensitivity analyses suggested improved outcomes at lower GAs for inborns. CONCLUSION In this GA and steroid matched cohort, there was no difference in survival without moderate-to-severe neurodevelopmental impairment to 5.5 years of age between inborn and outborn very preterm children. This suggests steroids might be important in determining outcomes.
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Affiliation(s)
- Peter Jones
- SAMU de Paris, Necker-Enfants Malades Hospitals, Paris, France.,Paediatric Intensive Care, Hôpital Robert Debré, Robert-Debré Mother-Child University Hospital Mobile Service of Urgences and Reanimation, Paris, France
| | - Laetitia Marchand-Martin
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Université Paris Cité, INSERM, INRAE, Paris, France
| | - Thomas Desplanches
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Université Paris Cité, INSERM, INRAE, Paris, France.,Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland.,Pôle de Gynécologie-Obstétrique, Médecine Fœtale et Stérilité Conjugale, Dijon University Hospital, Dijon, France
| | - Caroline Diguisto
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Université Paris Cité, INSERM, INRAE, Paris, France.,Maternité Olympe de Gouges, CHRU Tours Pôle de Gynécologie Obstétrique Médecine fœtale et Reproduction, Tours, France
| | - Jeanne Fresson
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Université Paris Cité, INSERM, INRAE, Paris, France.,Population Health Office, DREES, Paris, France.,Department of Medical Information, University Hospital (CHRU) Nancy, Nancy, France
| | - François Goffinet
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Université Paris Cité, INSERM, INRAE, Paris, France.,Department of Obstetrics and Gynaecology, Maternité Port-Royal, Association Publique - Hôpitaux de Paris, Paris, France
| | - Stéphane Dauger
- Paediatric Intensive Care Unit, Robert-Debré Mother-Child University Hospital, Paris, France
| | - Pierre-Yves Ancel
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Université Paris Cité, INSERM, INRAE, Paris, France.,Clinical Investigation Center P1419, APHP, Paris, France
| | - Andrei Scott Morgan
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Université Paris Cité, INSERM, INRAE, Paris, France .,EGA Institute for Women's Health, UCL, London, UK.,Pôle Femmes-Parents-Enfants, Service de réanimation et médecine néonatale, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France
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12
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Hirata K, Ueda K, Wada K, Ikehara S, Tanigawa K, Kimura T, Ozono K, Iso H. Pregnancy outcomes after preterm premature rupture of membranes: The Japan Environment and Children's Study. J Obstet Gynaecol Res 2022; 48:2756-2765. [DOI: 10.1111/jog.15388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/26/2022] [Accepted: 07/22/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Katsuya Hirata
- Department of Neonatal Medicine Osaka Women's and Children's Hospital Osaka Japan
| | - Kimiko Ueda
- Osaka Maternal and Child Health Information Center Osaka Women's and Children's Hospital Osaka Japan
| | - Kazuko Wada
- Department of Neonatal Medicine Osaka Women's and Children's Hospital Osaka Japan
| | - Satoyo Ikehara
- Public Health, Department of Social Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Kanami Tanigawa
- Osaka Maternal and Child Health Information Center Osaka Women's and Children's Hospital Osaka Japan
- Public Health, Department of Social Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology Osaka University Graduate School of Medicine Osaka Japan
| | - Keiichi Ozono
- Department of Pediatrics Osaka University Graduate School of Medicine Osaka Japan
| | - Hiroyasu Iso
- Osaka Regional Center for Japan Environment and Children's Study (JECS) Osaka University Osaka Japan
- Institute for Global Health Policy Research, Bureau of International Health Cooperation National Center for Global Health and Medicine Tokyo Japan
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13
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Hayakawa K, Tanda K, Nishimoto M, Nishimura A, Kinoshita D, Sano Y. The Incidence of Intraventricular Hemorrhage in Low-Birth-Weight Infants: Assessment by Magnetic Resonance Imaging. Neuropediatrics 2022; 53:246-250. [PMID: 35843217 DOI: 10.1055/s-0042-1750736] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE Intraventricular hemorrhage (IVH) is common in infants with a low-birth-weight (LBW) and has been suggested to cause major impairment not only of future motor development but also of cognitive function and learning ability. The purpose of the present study is to assess the frequency of IVH using magnetic resonance imaging (MRI) in LBW infants and its clinical neurodevelopmental outcomes. METHODS We enrolled a consecutive series of 247 neonates with an LBW of < 1,500 g hospitalized in the newborn intensive care unit between 2010 and 2015. The presence of IVH was examined using T2* MRI at term-equivalent age (TEA). We then investigated the clinical outcome at ≥3 years of age and its correlation with the IVH grade. RESULTS The overall incidence of IVH among LBW infants was 16.2%. The proportion of infants with IVH showing a favorable outcome did not differ significantly from that of infants without IVH. The proportion of neonates showing a poor outcome was 6.7% for those with IVH and 1.9% for those without IVH and 2.7% for those with and without IVH combined. CONCLUSION We were able to clarify the frequency of IVH in LBW infants using MRI at TEA. We demonstrated the lower incidence of mortality and IVH, the higher incidence of a favorable outcome, and the lower incidence of poor outcome.
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Affiliation(s)
- Katsumi Hayakawa
- Department of Diagnostic Radiology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Koichi Tanda
- Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan.,Department of Pediatrics, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Masakazu Nishimoto
- Department of Diagnostic Radiology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Akira Nishimura
- Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Daisuke Kinoshita
- Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Yuko Sano
- Department of Diagnostic Radiology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
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14
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Long-term outcomes of children with neonatal transfer: the Japan Environment and Children's Study. Eur J Pediatr 2022; 181:2501-2511. [PMID: 35333975 PMCID: PMC9889501 DOI: 10.1007/s00431-022-04450-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/09/2022] [Accepted: 03/16/2022] [Indexed: 02/04/2023]
Abstract
This study aimed to evaluate the association of neonatal transfer with the risk of neurodevelopmental outcomes at 3 years of age. Data were obtained from the Japan Environment and Children's Study. A general population of 103,060 pregnancies with 104,062 fetuses was enrolled in the study in 15 Regional Centers between January 2011 and March 2014. Live-born singletons at various gestational ages, including term infants, without congenital anomalies who were followed up until 3 years were included. Neurodevelopmental impairment was assessed using the Ages and Stages Questionnaire, third edition (ASQ-3) at 3 years of age. Logistic regression was used to estimate the adjusted risk and 95% confidence interval (CI) for newborns with neonatal transfer. Socioeconomic and perinatal factors were included as potential confounders in the analysis. Among 83,855 live-born singletons without congenital anomalies, 65,710 children were studied. Among them, 2780 (4.2%) were transferred in the neonatal period. After adjustment for potential confounders, the incidence of neurodevelopmental impairment (scores below the cut-off value of all 5 domains in the ASQ-3) was higher in children with neonatal transfer compared with those without neonatal transfer (communication: 6.5% vs 3.5%, OR 1.42, 95% CI 1.19-1.70; gross motor: 7.6% vs 4.0%, OR 1.26, 95% CI 1.07-1.49; fine motor: 11.3% vs 7.1%, OR 1.19, 95% CI 1.03-1.36; problem solving: 10.8% vs 6.8%, OR 1.29, 95% CI 1.12-1.48; and personal-social: 6.2% vs 2.9%, OR 1.52, 95% CI 1.26-1.83). Conclusion: Neonatal transfer was associated with a higher risk of neurodevelopmental impairment at 3 years of age. What is Known: • Neonatal transfer after birth in preterm infants is associated with adverse short-term outcomes. • Long-term outcomes of outborn infants with neonatal transfer in the general population remain unclear. What is New: • This study suggests that neonatal transfer at birth is associated with an increased risk of neurodevelopmental impairment. • Efforts for referring high-risk pregnant women to higher level centers may reduce the incidence of neonatal transfer, leading to improved neurological outcomes in the general population.
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15
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Collados-Gómez L, Esteban-Gonzalo L, López-López C, Jiménez-Fernández L, Piris-Borregas S, García-García E, Fernández-Gonzalo JC, Martínez-Miguel E. Lateral Kangaroo Care in Hemodynamic Stability of Extremely Preterm Infants: Protocol Study for a Non-Inferiority Randomized Controlled Trial CANGULAT. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:293. [PMID: 35010554 PMCID: PMC8750690 DOI: 10.3390/ijerph19010293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/15/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION This study aims to assess the efficacy of the modified kangaroo care lateral position on the thermal stability of preterm neonates versus conventional kangaroo care prone position. MATERIAL AND METHODS A non-inferiority randomized parallel clinical trial. Kangaroo care will be performed in a lateral position for the experimental group and in a prone position for the control group preterm. The study will take place at the neonatal intensive care unit (NICU) of a University Hospital. The participants will be extremely premature infants (under 28 weeks of gestational age) along the first five days of life, hemodynamically stable, with mother or father willing to do kangaroo care and give their written consent to participate in the study. The sample size calculated was 35 participants in each group. When the premature infant is hemodynamically stable and one of the parents stays in the NICU, the patient will be randomized into two groups: an experimental group or a control group. The primary outcome is premature infant axillary temperature. Neonatal pain level and intraventricular hemorrhage are secondary outcomes. DISCUSSION There is no scientific evidence on modified kangaroo care lateral position. Furthermore, there is little evidence of increased intraventricular hemorrhage association with the lateral head position necessary in conventional or prone kangaroo care in extremely premature newborns. Kangaroo care is a priority intervention in neonatal units increasing the time of use more and more, making postural changes necessary to optimize comfort and minimize risks with kangaroo care lateral position as an alternative to conventional prone position kangaroo care. Meanwhile, it is essential to ensure that the conventional kangaroo care prone position, which requires the head to lay sideways, is a safe position in terms of preventing intraventricular hemorrhage in the first five days of life of children under 28 weeks of gestational age. Trial registration at clinicaltrials.gov: NCT03990116.
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Affiliation(s)
- Laura Collados-Gómez
- Faculty of Biomedicine, Nursing and Nutrition Department, Universidad Europea de Madrid, 28670 Madrid, Spain; (L.C.-G.); (E.G.-G.); (J.C.F.-G.); (E.M.-M.)
- Department of Neonatal Intensive Care, Hospital Universitario 12 de Octubre, (H12O), 28041 Madrid, Spain; (C.L.-L.); (L.J.-F.); (S.P.-B.)
- Care Research Group (Invecuid), Instituto de Investigación Sanitaria 12 de Octubre (imas12), 28041 Madrid, Spain
| | - Laura Esteban-Gonzalo
- Faculty of Biomedicine, Nursing and Nutrition Department, Universidad Europea de Madrid, 28670 Madrid, Spain; (L.C.-G.); (E.G.-G.); (J.C.F.-G.); (E.M.-M.)
- Faculty of Nursing, Physiotherapy and Podiatry, Nursing Department, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Candelas López-López
- Department of Neonatal Intensive Care, Hospital Universitario 12 de Octubre, (H12O), 28041 Madrid, Spain; (C.L.-L.); (L.J.-F.); (S.P.-B.)
- Care Research Group (Invecuid), Instituto de Investigación Sanitaria 12 de Octubre (imas12), 28041 Madrid, Spain
- Faculty of Nursing, Physiotherapy and Podiatry, Nursing Department, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Lucía Jiménez-Fernández
- Department of Neonatal Intensive Care, Hospital Universitario 12 de Octubre, (H12O), 28041 Madrid, Spain; (C.L.-L.); (L.J.-F.); (S.P.-B.)
| | - Salvador Piris-Borregas
- Department of Neonatal Intensive Care, Hospital Universitario 12 de Octubre, (H12O), 28041 Madrid, Spain; (C.L.-L.); (L.J.-F.); (S.P.-B.)
- Researcher at the Maternity and Childhood Health Research Group (Area 4), 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Esther García-García
- Faculty of Biomedicine, Nursing and Nutrition Department, Universidad Europea de Madrid, 28670 Madrid, Spain; (L.C.-G.); (E.G.-G.); (J.C.F.-G.); (E.M.-M.)
| | - Juan Carlos Fernández-Gonzalo
- Faculty of Biomedicine, Nursing and Nutrition Department, Universidad Europea de Madrid, 28670 Madrid, Spain; (L.C.-G.); (E.G.-G.); (J.C.F.-G.); (E.M.-M.)
| | - Esther Martínez-Miguel
- Faculty of Biomedicine, Nursing and Nutrition Department, Universidad Europea de Madrid, 28670 Madrid, Spain; (L.C.-G.); (E.G.-G.); (J.C.F.-G.); (E.M.-M.)
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16
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Abstract
Neonatal tele-resuscitation programs use synchronous audio-video telemedicine systems to connect neonatologists with community hospital care teams during high risk resuscitations. Using tele-resuscitation, remote neonatologists can visualize and actively guide the resuscitation and stabilization of at-risk neonates. The feasibility of tele-resuscitation has been proven, and early evidence suggests that tele-resuscitation improves the quality of care, reduces unnecessary medical transports, and may generate a net savings to the health system. Community hospital staff and remote neonatologists are highly satisfied with tele-resuscitation programs. Tele-resuscitation presents an opportunity to improve healthcare delivery for neonates regardless of their birth location. The neonatology community should work to identify and rigorously study the value tele-resuscitation can bring to neonates, their families, and care teams.
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Affiliation(s)
- Jennifer L Fang
- Division of Neonatal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.
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17
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Kusuda S, Bennett M, Gould J. Outcomes of Infants with Very Low Birth Weight Associated with Birthplace Difference: A Retrospective Cohort Study of Births in Japan and California. J Pediatr 2021; 229:182-190.e6. [PMID: 33058856 DOI: 10.1016/j.jpeds.2020.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/26/2020] [Accepted: 10/06/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine whether outcomes among infants with very low birth weight (VLBW) vary according to the birthplace (Japan or California) controlling for maternal ethnicity. STUDY DESIGN Severe intraventricular hemorrhage (IVH) and mortality were ascertained for infants with VLBW born at 24-29 weeks of gestation during 2008-2017 and retrospectively analyzed by the country of birth for mothers and infants (Japan or California). RESULTS Rates of severe IVH, mortality, or combined IVH/mortality were lower in the 24 095 infants born in Japan (5.1%, 5.0%, 8.8% respectively) compared with infants born in California either to 157 mothers with Japanese ethnicity (12.5%, 9.7%, 17.8%) or to a comparison group of 6173 non-Hispanic white mothers (8.4%, 8.8%, 14.6%). ORs for adverse outcomes were increased for infants born in California to mothers with Japanese ethnicity compared with infants born in Japan for severe IVH (OR, 3.31; 95% CI, 1.93-5.68), mortality (3.73; 95% CI, 2.03-6.86), and the combined outcome (3.26; 95% CI, 2.02-5.27). The odds of these outcomes also were increased for infants born in California to non-Hispanic white mothers compared with infants born in Japan. Outcomes of infants born in California did not differ by Japanese or non-Hispanic white maternal ethnicity. CONCLUSIONS Low rates of severe IVH and mortality for infants with VLBW born in Japan were not seen in infants born in California to mothers with Japanese ethnicity. Differences in systems of regional perinatal care, social environment, and the quality of perinatal care may partially account for these differences in outcomes.
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Affiliation(s)
- Satoshi Kusuda
- Department of Pediatrics, Kyorin University, Tokyo, Japan.
| | - Mihoko Bennett
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics Stanford University School of Medicine, CA
| | - Jeffrey Gould
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics Stanford University School of Medicine, CA
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