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Dolma K, Zayek M, Gurung A, Eyal F. Intratracheal Instillation of Budesonide-Surfactant for Prevention of Bronchopulmonary Dysplasia in Extremely Premature Infants. Am J Perinatol 2024; 41:e3065-e3073. [PMID: 37913780 DOI: 10.1055/s-0043-1776416] [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: 11/03/2023]
Abstract
OBJECTIVE This study aimed to determine the effect of intratracheal instillation of a budesonide-surfactant combination on the incidence of bronchopulmonary dysplasia (BPD) or death compared with surfactant alone in extremely preterm infants. STUDY DESIGN In this retrospective, single-center study, we included extremely preterm infants (<28 weeks' gestation) who received surfactant for respiratory distress in the first 3 days of life. We compared infants who received budesonide-surfactant combination (intervention group: infants born between February 2016 and October 2021) with surfactant alone (control group: infants born from January 2010 through January 2016). The primary outcome was a composite of BPD grade 2 or 3 (as defined by Jensen et al, 2019) or death before 36 weeks' postmenstrual age (PMA). RESULTS We included 966 extremely preterm infants (528 in the control group and 438 in the intervention group). While the incidence of death/BPD grade 2 or 3 at 36 weeks of PMA was not different between the two groups (66% in the intervention group vs. 63% in the control group; adjusted relative risk [aRR], 0.99; 95% confidence interval [CI], 0.90-1.07; p-value = 0.69), budesonide was associated with a reduction in the primary outcome only in a subgroup of infants with birth weight ≥ 750 grams (36.8 vs. 43.5%, respectively; aRR 0.75; 95% CI, 0.57-0.98). Primary and secondary outcomes did not differ between the two groups within the subgroup of infants weighing <750 grams. CONCLUSION In extremely preterm infants, the budesonide-surfactant combination therapy reduced the rates of BPD or death in infants weighing ≥750 grams; however, this beneficial effect was not seen in infants weighing <750 grams. Further investigation of this treatment may be indicated before it is considered a standard approach to management. KEY POINTS · Intratracheal budesonide-surfactant therapy reduces BPD in preterm infants weighing ≥750 grams.. · Intratracheal budesonide-surfactant therapy does not affect BPD in preterm infants weighing <750 grams.. · Intratracheal budesonide-surfactant therapy does not affect the mortality rate in preterm infants..
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Affiliation(s)
- Kalsang Dolma
- Department of Pediatrics, Division of Neonatology, University of South Alabama, Mobile, Alabama
| | - Michael Zayek
- Department of Pediatrics, Division of Neonatology, University of South Alabama, Mobile, Alabama
| | - Aayushka Gurung
- Department of Pediatrics, Division of Neonatology, University of South Alabama, Mobile, Alabama
| | - Fabien Eyal
- Department of Pediatrics, Division of Neonatology, University of South Alabama, Mobile, Alabama
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Hong YM, Cho DH, Kim JK. Developmental outcomes of very low birth weight infants with catch-up head growth: a nationwide cohort study. BMC Pediatr 2023; 23:392. [PMID: 37553623 PMCID: PMC10408187 DOI: 10.1186/s12887-023-04135-6] [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: 03/18/2023] [Accepted: 06/16/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND As the survival rates of very low birth weight (VLBW) infants have increased, their neurodevelopmental outcomes are of concern. This study aims to determine the demographic and perinatal characteristics of premature infant according to head growth, identify clinical factors affecting growth catch-up, and explore differences in developmental outcomes according to catch-up states. METHODS This nationwide prospective cohort study of Korean Neonatal Network data analyzed premature infants with very low birth weight (< 1,500 g) between 2014 and 2017. A total of 253 eligible infants who had completed the Bayley Scales of Infant and Toddler Development, Third Edition, were assigned into two groups: a catch-up (CU) group with a head circumference above the 10th percentile and a no catch-up (NCU) group with a head circumference below the 10th percentile at 18-24 months of corrected age (CA). RESULTS Most (81.4%, 206/253) premature infants exhibited catch-up growth at 18-24 months of CA. Rates of microcephaly, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), sepsis, necrotizing enterocolitis (NEC), length of NICU stay, ventilation care, and parenteral nutrition were significantly greater in the NCU group (P < 0.05). On multiple linear regression analysis, BPD status was the most influential clinical factor affecting catch-up head growth after adjusting for gestational age, birth weight, and birth head circumference (adjusted OR 4.586, 95% CI 1.960-10.729). At 18-24 months of CA, the NCU group exhibited lower developmental indices and a higher rate of developmental delay than the CU group. Motor developmental delay was the most significant factor relevant to catch-up head growth, and the motor development difference between the two groups was only statistically significant after adjusting for four major neonatal morbidities: IVH, BPD, sepsis, and NEC status (adjusted OR 10.727, 95% CI 1.922-59.868). CONCLUSION As association was observed between head growth catch-up status and developmental outcomes in VLBW infants at 18-24 months of CA. Key clinical factors associated with catch-up status included BPD and NEC status, length of parenteral nutrition, and ventilator care. Further study is needed to establish causality and explore additional factors that may influence developmental outcomes in this population.
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Affiliation(s)
- You Mi Hong
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong Hue Cho
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
- Department of Obstetrics and Gynecology, Jeonbuk National University School of Medicine, Jeonju, Korea
| | - Jin Kyu Kim
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea.
- Department of Pediatrics, Jeonbuk National University School of Medicine, Jeonju, Korea.
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Chioma R, Sbordone A, Patti ML, Perri A, Vento G, Nobile S. Applications of Artificial Intelligence in Neonatology. APPLIED SCIENCES 2023; 13:3211. [DOI: 10.3390/app13053211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
The development of artificial intelligence methods has impacted therapeutics, personalized diagnostics, drug discovery, and medical imaging. Although, in many situations, AI clinical decision-support tools may seem superior to rule-based tools, their use may result in additional challenges. Examples include the paucity of large datasets and the presence of unbalanced data (i.e., due to the low occurrence of adverse outcomes), as often seen in neonatal medicine. The most recent and impactful applications of AI in neonatal medicine are discussed in this review, highlighting future research directions relating to the neonatal population. Current AI applications tested in neonatology include tools for vital signs monitoring, disease prediction (respiratory distress syndrome, bronchopulmonary dysplasia, apnea of prematurity) and risk stratification (retinopathy of prematurity, intestinal perforation, jaundice), neurological diagnostic and prognostic support (electroencephalograms, sleep stage classification, neuroimaging), and novel image recognition technologies, which are particularly useful for prompt recognition of infections. To have these kinds of tools helping neonatologists in daily clinical practice could be something extremely revolutionary in the next future. On the other hand, it is important to recognize the limitations of AI to ensure the proper use of this technology.
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Affiliation(s)
- Roberto Chioma
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Annamaria Sbordone
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Maria Letizia Patti
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Alessandro Perri
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giovanni Vento
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Stefano Nobile
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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Dettman RW, Dizon MLV. How lung injury and therapeutic oxygen could alter white matter development. J Neurosci Res 2022; 100:2127-2137. [PMID: 33687103 PMCID: PMC8426430 DOI: 10.1002/jnr.24816] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 01/07/2023]
Abstract
Developmental brain injury describes a spectrum of neurological pathologies resulting from either antenatal or perinatal injury. This includes both cognitive and motor defects that affect patients for their entire lives. Developmental brain injury can be caused by a spectrum of conditions including stroke, perinatal hypoxia-ischemia, and intracranial hemorrhage. Additional risk factors have been identified including very low birth weight, mechanical ventilation, and oxygen (O2 ) supplementation. In fact, infants with bronchopulmonary dysplasia, an inflammatory disease associated with disrupted lung development, have been shown to have decreased cerebral white matter and decreased intracranial volumes. Thus, there appears to be a developmental link between the lung, O2 , and the brain that leads to proper myelination. Here, we will discuss what is currently known about the link between O2 and myelination and how scientists are exploring mechanisms through which supplemental O2 and/or lung injury can affect brain development. Consideration of a link between the diseased lung and developing brain will allow clinicians to fine tune their approaches in managing preterm lung disease in order to optimize brain health.
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Affiliation(s)
- Robert W. Dettman
- Perinatal Origins of Disease, Stanley Manne Children’s Research Institute, Chicago, IL 60611
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago IL, 60611
| | - Maria L. V. Dizon
- Perinatal Origins of Disease, Stanley Manne Children’s Research Institute, Chicago, IL 60611
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago IL, 60611
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Safety of sildenafil in premature infants at risk of bronchopulmonary dysplasia: Rationale and methods of a phase II randomized trial. Contemp Clin Trials Commun 2022; 30:101025. [PMID: 36345347 PMCID: PMC9636444 DOI: 10.1016/j.conctc.2022.101025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/18/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is a disease of chronic respiratory insufficiency stemming from premature birth and iatrogenic lung injury leading to alveolar simplification, impaired alveolar-capillary development, interstitial fibrosis, and often pulmonary hypertension. BPD is the most common pulmonary sequela of prematurity and is often fatal; however, there remains no FDA-approved therapies to treat or prevent BPD. Sildenafil is increasingly used off-label in premature infants despite scant safety and efficacy data. Sildenafil reduces lung injury and preserves normal vasculature in preclinical models, and improves outcomes in children with pulmonary hypertension, and thus is a promising candidate for BPD. Following phase I studies, we developed the phase II SIL02 trial to describe the safety, pharmacokinetics and preliminary effectiveness of intravenous and enteral sildenafil in premature infants at risk for BPD. SIL02 is a randomized, double-blind, placebo-controlled, 3-cohort, sequential dose-escalating trial of enteral or intravenous (IV) sildenafil dosed every 8 h for up to 34 days. The target IV doses were 0.125, 0.5 and 1 mg/kg/dose in cohorts 1, 2 and 3, respectively; while the enteral doses will be double the IV doses. Eligible infants must be < 29 weeks' gestation at birth and requiring respiratory support at 7–28 days' postnatal age. Adverse events and preliminary effectiveness will be compared by treatment group. Using the final population PK model, empirical Bayesian estimates will be generated for each patient. Preliminary effectiveness will be measured by the incidence of moderate to severe BPD or death at 36 weeks and change in the BPD risk estimation.
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Hoshino Y, Arai J, Miura R, Takeuchi S, Yukitake Y, Kajikawa D, Kamakura T, Horigome H. Lung Ultrasound for Predicting the Respiratory Outcome in Patients with Bronchopulmonary Dysplasia. Am J Perinatol 2022; 39:1229-1235. [PMID: 33374021 DOI: 10.1055/s-0040-1721848] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study aimed to investigate the utility of lung ultrasound (LUS) with whole chest scanning for predicting respiratory outcomes in patients with bronchopulmonary dysplasia (BPD). STUDY DESIGN We performed a prospective observational study. Preterm infants of less than 32 weeks' gestational age requiring oxygen therapy at 28 days of life were included. LUS was performed on day 28, at 36 weeks' postmenstrual age, and at the time of discharge. Each lung was divided into three regions by the anterior and posterior axillary lines and received an LUS score of 0 to 3 points; the total score was obtained by adding the six regional scores. The classification of BPD was determined based on the National Institute of Child and Human Development. The outcomes of this study were the development of moderate-to-severe BPD and the need for home oxygen therapy (HOT). RESULTS We enrolled 87 patients; 39, 33, and 15 infants had mild, moderate, and severe BPD, respectively. The LUS score correlated with BPD severity and exhibited an improvement trend with time toward the point of discharge. LUS at 28 days of life predicted moderate-to-severe BPD with an area under the curve of 0.95 (95% confidence interval: 0.91-0.99) and HOT with an area under the curve of 0.95 (95% confidence interval: 0.81-1.0). CONCLUSION LUS with whole chest scanning is useful for predicting respiratory outcomes in patients with BPD, as well as for understanding BPD severity or clinical improvement trends. KEY POINTS · LUS predicts respiratory outcomes in patients with BPD.. · LUS indicates BPD severity.. · LUS can show clinical improvement with time..
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Affiliation(s)
- Yusuke Hoshino
- Department of Neonatology, Ibaraki Children's Hospital, Mito, Japan
| | - Junichi Arai
- Department of Neonatology, Ibaraki Children's Hospital, Mito, Japan
| | - Rena Miura
- Department of Neonatology, Ibaraki Children's Hospital, Mito, Japan
| | - Syusuke Takeuchi
- Department of Neonatology, Ibaraki Children's Hospital, Mito, Japan
| | - Yoshiya Yukitake
- Department of Neonatology, Ibaraki Children's Hospital, Mito, Japan
| | - Daigo Kajikawa
- Department of Neonatology, Ibaraki Children's Hospital, Mito, Japan
| | - Tae Kamakura
- Department of Neonatology, Ibaraki Children's Hospital, Mito, Japan
| | - Hitoshi Horigome
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Greenberg RG, McDonald SA, Laughon MM, Tanaka D, Jensen E, Van Meurs K, Eichenwald E, Brumbaugh JE, Duncan A, Walsh M, Das A, Cotten CM. Online clinical tool to estimate risk of bronchopulmonary dysplasia in extremely preterm infants. Arch Dis Child Fetal Neonatal Ed 2022; 107:fetalneonatal-2021-323573. [PMID: 35728925 PMCID: PMC9768097 DOI: 10.1136/archdischild-2021-323573] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/30/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Develop an online estimator that accurately predicts bronchopulmonary dysplasia (BPD) severity or death using readily-available demographic and clinical data. DESIGN Retrospective analysis of data entered into a prospective registry. SETTING Infants cared for at centres of the United States Neonatal Research Network between 2011 and 2017. PATIENTS Infants 501-1250 g birth weight and 23 0/7-28 6/7 weeks' gestation. INTERVENTIONS None. MAIN OUTCOME MEASURES Separate multinomial regression models for postnatal days 1, 3, 7, 14 and 28 were developed to estimate the individual probabilities of death or BPD severity (no BPD, grade 1 BPD, grade 2 BPD, grade 3 BPD) defined according to the mode of respiratory support administered at 36 weeks' postmenstrual age. RESULTS Among 9181 included infants, birth weight was most predictive of death or BPD severity on postnatal day 1, while mode of respiratory support was the most predictive factor on days 3, 7, 14 and 28. The predictive accuracy of the models increased at each time period from postnatal day 1 (C-statistic: 0.674) to postnatal day 28 (C-statistic 0.741). We used these results to develop a web-based model that provides predicted estimates for BPD by postnatal day. CONCLUSION The probability of BPD or death in extremely preterm infants can be estimated with reasonable accuracy using a limited amount of readily available clinical information. This tool may aid clinical prognostication, future research, and center-specific quality improvement surrounding BPD prevention. TRIAL REGISTRATION NUMBER NCT00063063.
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Affiliation(s)
- Rachel G Greenberg
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Matthew M Laughon
- Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David Tanaka
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Erik Jensen
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Krisa Van Meurs
- Division of Neonatology, Lucile Packard Children's Hospital, Palo Alto, California, USA
| | - Eric Eichenwald
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jane E Brumbaugh
- Department of Pediatrics, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Andrea Duncan
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Michele Walsh
- Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Abhik Das
- RTI International, Rockville, Maryland, USA
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Sindelar R, Nakanishi H, Stanford AH, Colaizy TT, Klein JM. Respiratory management for extremely premature infants born at 22 to 23 weeks of gestation in proactive centers in Sweden, Japan, and USA. Semin Perinatol 2022; 46:151540. [PMID: 34872750 DOI: 10.1016/j.semperi.2021.151540] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Survival of preterm newborn infants have increased steadily since the introduction of surfactant treatment and antenatal steroids. In the absence of randomized controlled trials on ventilatory strategies in extremely preterm infants, we present ventilatory strategies applied during the initial phase and the continued ventilatory care as applied in three centers with proactive prenatal and postnatal management and well documented good outcomes in terms of mortality and morbidity in this cohort of infants.
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Affiliation(s)
- Richard Sindelar
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Hidehiko Nakanishi
- Research and Development Center for New Medical Frontiers, Division of Neonatal Intensive Care Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Amy H Stanford
- Division of Neonatology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Tarah T Colaizy
- Division of Neonatology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Jonathan M Klein
- Division of Neonatology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
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DiLabio J, Zwicker JG, Sherlock R, Daspal S, Shah PS, Shah V. Maternal age and long-term neurodevelopmental outcomes of preterm infants < 29 weeks gestational age. J Perinatol 2021; 41:1304-1312. [PMID: 32694856 DOI: 10.1038/s41372-020-0735-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/09/2020] [Accepted: 07/07/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study is to assess the impact of maternal age on neurodevelopmental (ND) outcomes of infants < 29 weeks gestational age (GA) at 18-24 months. STUDY DESIGN A retrospective cohort study of preterm infants < 29 weeks GA admitted to Canadian tertiary NICUs was performed. The primary outcome was a composite of death or ND impairment (NDI)/significant NDI (sNDI) at 18-24 months. Association between maternal age and outcome was assessed across maternal age groups (15-19, 20-34, 35-39 and ≥40 years) using logistic regression after adjusting for confounders. RESULTS Of 3691 eligible infants, 2652 with complete data were included in the analysis. Significant differences in maternal characteristics existed across age groups. The only difference in neonatal characteristics was the incidence of bronchopulmonary dysplasia (p < 0.01). There was no association between maternal age and death or NDI/sNDI after controlling for confounders. CONCLUSION Maternal age is not associated with differences in NDI/sNDI rates among Canadian preterm infants < 29 weeks GA.
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Affiliation(s)
- Julia DiLabio
- Division of Neonatology, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Jill G Zwicker
- Department of Occupational Science & Occupational Therapy and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Rebecca Sherlock
- Division of Neonatology, Surrey Memorial Hospital, Surrey, BC, Canada
| | - Sibasis Daspal
- Division of Neonatology, Royal University Hospital, Saskatoon, SK, Canada
| | - Prakesh S Shah
- Division of Neonatology, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Vibhuti Shah
- Division of Neonatology, Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
- Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada.
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Frantz MF, Schaefer MP, Donelli TMS. Follow-Up de Nascidos Prematuros: Uma Revisão Sistemática da Literatura. PSICOLOGIA: TEORIA E PESQUISA 2021. [DOI: 10.1590/0102.3772e37316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivou-se mapear estudos científicos sobre follow-up de prematuros na área da psicologia. Buscou-se no portal BVS artigos empíricos publicados até dezembro de 2017 pelos descritores prematur* AND follow up AND child AND psychology. A partir dos critérios adotados, analisou-se 48 artigos, nas categorias: faixa etária em que os prematuros foram avaliados; objetivos do estudo; tipo de avaliação realizada; e resultados encontrados. Destaca-se que a metade realizou o follow-up entre o nascimento e a adolescência, a maioria investigou o desenvolvimento neuropsicológico e encontrou associações entre a prematuridade, déficits cognitivos e psicológicos. Compreende-se que os estudos priorizam as repercussões no desenvolvimento de habilidades e competências, dando pouca atenção aos aspectos psíquicos e às interações criança-pais-ambiente.
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Abstract
In the absence of effective interventions to prevent preterm births, improved survival of infants who are born at the biological limits of viability has relied on advances in perinatal care over the past 50 years. Except for extremely preterm infants with suboptimal perinatal care or major antenatal events that cause severe respiratory failure at birth, most extremely preterm infants now survive, but they often develop chronic lung dysfunction termed bronchopulmonary dysplasia (BPD; also known as chronic lung disease). Despite major efforts to minimize injurious but often life-saving postnatal interventions (such as oxygen, mechanical ventilation and corticosteroids), BPD remains the most frequent complication of extreme preterm birth. BPD is now recognized as the result of an aberrant reparative response to both antenatal injury and repetitive postnatal injury to the developing lungs. Consequently, lung development is markedly impaired, which leads to persistent airway and pulmonary vascular disease that can affect adult lung function. Greater insights into the pathobiology of BPD will provide a better understanding of disease mechanisms and lung repair and regeneration, which will enable the discovery of novel therapeutic targets. In parallel, clinical and translational studies that improve the classification of disease phenotypes and enable early identification of at-risk preterm infants should improve trial design and individualized care to enhance outcomes in preterm infants.
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Bolisetty S, Tiwari M, Sutton L, Schindler T, Bajuk B, Lui K. Neurodevelopmental outcomes of extremely preterm infants in New South Wales and the Australian Capital Territory. J Paediatr Child Health 2019; 55:956-961. [PMID: 30499234 DOI: 10.1111/jpc.14323] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 10/23/2018] [Accepted: 11/09/2018] [Indexed: 11/27/2022]
Abstract
AIM This study aimed to provide updated information on gestation-specific neurodevelopmental outcomes of extremely to very preterm infants 23-28 weeks' gestation admitted to neonatal intensive care units (NICUs). METHODS This was a population-based retrospective cohort study of infants born between 23+0 and 28+6 weeks' gestation and admitted to a network of NICUs between 2007 and 2012 in a well-defined geographic area of New South Wales (NSW) and the Australian Capital Territory (ACT). Primary outcome was moderate to severe neurodevelopmental impairment. RESULTS Of 2287 infants admitted to NICUs, 1914 (83.7%) survived to discharge, and 1514 (79.8% = 1514/1897) were followed up. Moderate to severe neurodevelopmental impairment was 11% overall, and the incidence decreased with increasing gestational age (GA): 25, 23, 15, 13, 9 and 7% at 23, 24, 25, 26, 27 and 28 weeks, respectively. Male gender, major intraventricular haemorrhage, late-onset sepsis, chronic lung disease and post-natal corticosteroid therapy were found to be independently associated with increased risk of moderate to severe impairment. Compared with an incidence of 16% in the 1998-2004 cohort, there was a significant reduction in moderate to severe neurodevelopmental impairment in the current cohort (unadjusted odds ratio: 0.65, 95% confidence interval: 0.52-0.80). CONCLUSIONS We report the latest neurodevelopmental outcomes of extremely to very preterm infants in NSW and the ACT. Neurodevelopmental outcome rates based on GA alone may not provide the true estimate as these outcomes can vary based on the presence or absence of other relevant perinatal factors.
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Affiliation(s)
- Srinivas Bolisetty
- Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mudita Tiwari
- Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Lee Sutton
- Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Timothy Schindler
- Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Barbara Bajuk
- Perinatal Services Network, Sydney, New South Wales, Australia
| | - Kei Lui
- Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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Greenberg RG, Gayam S, Savage D, Tong A, Gorham D, Sholomon A, Clark RH, Benjamin DK, Laughon M, Smith PB. Furosemide Exposure and Prevention of Bronchopulmonary Dysplasia in Premature Infants. J Pediatr 2019; 208:134-140.e2. [PMID: 30579586 PMCID: PMC6486845 DOI: 10.1016/j.jpeds.2018.11.043] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/31/2018] [Accepted: 11/26/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the association between furosemide exposure and risk of bronchopulmonary dysplasia (BPD). STUDY DESIGN This retrospective cohort study included infants (2004-2015) born at 23-29 weeks gestational age and 501-1249 g birth weight. We compared the demographic and clinical characteristics of infants exposed and not exposed to furosemide between postnatal day 7 and 36 weeks postmenstrual age. We examined the association between furosemide exposure and 2 outcomes: BPD and BPD or death. We performed multivariable probit regression models that included demographic and clinical variables in addition to 2 instrumental variables: furosemide exposure by discharge year, and furosemide exposure by site. RESULTS Of 37 693 included infants, 19 235 (51%) were exposed to furosemide; these infants were more premature and had higher respiratory support. Of 33 760 infants who survived to BPD evaluation, 15 954 (47%) had BPD. An increase in the proportion of furosemide exposure days by 10 percentage points was associated with a decrease in both the incidence of BPD (4.6 percentage points; P = .001), and BPD or death (3.7 percentage points; P = .01). CONCLUSIONS More days of furosemide exposure between postnatal day 7 and 36 weeks was associated with decreased risk of BPD and a combined outcome of BPD or death.
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Affiliation(s)
- Rachel G Greenberg
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
| | - Sreepriya Gayam
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Destiny Savage
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Andrew Tong
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Daniel Gorham
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Ari Sholomon
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Reese H Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL
| | | | - Matthew Laughon
- Department of Pediatrics, The University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - P Brian Smith
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
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Curley MAQ, Watson RS, Cassidy AM, Burns C, Delinger RL, Angus DC, Asaro LA, Wypij D, Beers SR. Design and rationale of the "Sedation strategy and cognitive outcome after critical illness in early childhood" study. Contemp Clin Trials 2018; 72:8-15. [PMID: 30017814 PMCID: PMC6914341 DOI: 10.1016/j.cct.2018.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/25/2018] [Accepted: 07/09/2018] [Indexed: 11/17/2022]
Abstract
There is increasing concern that sedatives commonly used during critical illness may be neurotoxic during the period of early brain development. The Sedation strategy and cognitive outcome after critical illness in early childhood (RESTORE-cognition) study is a prospective cohort study designed to examine the relationships between sedative exposure during pediatric critical illness and long-term neurocognitive outcomes. We assess multiple domains of neurocognitive function 2.5-5 years post-hospital discharge, at a single time point and depending on participant and clinician availability, in up to 500 subjects who had normal baseline cognitive function, were aged 2 weeks to 8 years at pediatric intensive care unit admission, and were enrolled in a cluster randomized controlled trial of a sedation protocol (the RESTORE trial; U01 HL086622 and HL086649). In addition, to provide comparable data on an unexposed group with similar baseline biological characteristics and environment, we are studying matched, healthy siblings of RESTORE patients. Our goal is to increase understanding of the relationships between sedative exposure, critical illness, and long-term neurocognitive outcomes in infants and young children by studying these subjects 2.5 to 5 years after their index hospitalization. This paper highlights the design challenges in conducting comprehensive neurocognitive assessment procedures across a broad age span at multiple testing centers across the United States. Our approach, which includes building interprofessional teams and novel cohort retention strategies, may be of help in future longitudinal trials.
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Affiliation(s)
- Martha A Q Curley
- From the School of Nursing, University of Pennsylvania, Philadelphia, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States; The Children's Hospital, Philadelphia Research Institute, Philadelphia, United States.
| | - R Scott Watson
- Department of Pediatrics, University of Washington, Seattle, United States; Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, United States
| | - Amy M Cassidy
- From the School of Nursing, University of Pennsylvania, Philadelphia, United States
| | - Cheryl Burns
- Department of Psychiatry, University of Pittsburgh School of Medicine, United States
| | - Rachel L Delinger
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, United States
| | - Derek C Angus
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States
| | - Lisa A Asaro
- Department of Cardiology, Boston Children's Hospital, Boston, United States
| | - David Wypij
- Department of Cardiology, Boston Children's Hospital, Boston, United States; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, United States; Department of Pediatrics, Harvard Medical School, Boston, United States
| | - Sue R Beers
- Department of Psychiatry, University of Pittsburgh School of Medicine, United States
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Lapcharoensap W, Lee HC, Nyberg A, Dukhovny D. Health Care and Societal Costs of Bronchopulmonary Dysplasia. Neoreviews 2018; 19:e211-e223. [PMID: 33384574 DOI: 10.1542/neo.19-4-e211] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Despite significant technological advances and increasing survival of premature infants, bronchopulmonary dysplasia (BPD) continues to be the most prevalent major morbidity in surviving very low-birthweight infants. Infants with BPD are often sicker, require longer stays in the NICU, and accumulate greater hospital costs. However, care of the infant with BPD extends beyond the time spent in the NICU. This article reviews the costs of BPD in the health-care setting, during the initial hospitalization and beyond, and the long-term neurodevelopmental impact of BPD, as well as the impact on a family caring for a child with BPD.
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Affiliation(s)
| | - Henry C Lee
- Department of Pediatrics, Stanford University, Stanford, CA
| | - Amy Nyberg
- March of Dimes NICU Family Support Coordinator, Helen DeVos Children's Hospital, Grand Rapids, MI
| | - Dmitry Dukhovny
- Department of Pediatrics, Oregon Health and Science University, Portland, OR
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Su YH, Jeng SF, Hsieh WS, Tu YK, Wu YT, Chen LC. Gross Motor Trajectories During the First Year of Life for Preterm Infants With Very Low Birth Weight. Phys Ther 2017; 97:365-373. [PMID: 28339607 DOI: 10.1093/ptj/pzx007] [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: 05/10/2016] [Accepted: 12/11/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Early identification of motor dysfunction in preterm infants with very low birth weight (VLBW) is important in order to provide early intervention. OBJECTIVE This study was to examine the motor trajectories of preterm infants with VLBW during their first year of life and to investigate the predictive ability and influencing factors of the trajectories. DESIGN AND METHODS A total of 342 preterm infants with VLBW were prospectively assessed for motor development by the Alberta Infant Motor Scales at 4, 6, 9, and 12 months and for developmental outcomes using the Bayley Scales of Infant and Toddler Development, second edition, at 24 months. Perinatal and socio-environmental factors were collected at baseline. Growth mixture modeling was used to explore the patterns of infants' motor trajectories during their first year of life. Logistic regression analyses were applied to examine the influencing factors associated with motor trajectories and their predictability of 24-month developmental outcomes. RESULTS Preterm infants with VLBW showed 3 distinct motor trajectories: stably normal (55%), deteriorating (32%), and persistently delayed (13%). Furthermore, the motor trajectories were predictive of 24-month cognitive and motor outcomes. Perinatal factors including lower birth weight, male gender, moderate to severe bronchopulmonary dysplasia, stage III to IV retinopathy of prematurity, and major brain damage were associated with a risk of deteriorating and persistently delayed trajectories (all P < .05). Socio-environmental factors had no association with motor trajectories. LIMITATIONS The small sample size of the infants with a persistently delayed trajectory may have limited the assessment of some influencing factors. CONCLUSION The identified early motor trajectories, predictive values, and influencing factors provide insightful implications for early detection and prevention of motor -disorders in preterm infants with VLBW.
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Affiliation(s)
- Yu-Han Su
- Y-H. Su, PT, MS, School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, and Physical Therapy, Department of Physical Medicine and Rehabilitation, Chang Gunh Memorial Hospital, Taoyuan, Taiwan
| | - Suh-Fang Jeng
- S-F. Jeng, PT, ScD, School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, and Physical Therapy Center, National Taiwan University Hospital, Taipei, -Taiwan
| | - Wu-Shiun Hsieh
- W-S. Hsieh, MD, Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Yu-Kang Tu
- Y-K. Tu, PhD, Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University
| | - Yen-Tzu Wu
- Y-T. Wu, PT, PhD, School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University
| | - Li-Chiou Chen
- L-C. Chen, PT, PhD, School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 17 Xu-Zhou Rd, Taipei 100, Taiwan, and Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan. Address all correspondence to Dr Chen at:
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17
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Follow-up at the corrected age of 24 months of preterm newborns receiving continuous infusion of fentanyl for pain control during mechanical ventilation. Pain 2017; 158:840-845. [DOI: 10.1097/j.pain.0000000000000839] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Ma J, Ye H. Effects of permissive hypercapnia on pulmonary and neurodevelopmental sequelae in extremely low birth weight infants: a meta-analysis. SPRINGERPLUS 2016; 5:764. [PMID: 27386250 PMCID: PMC4912505 DOI: 10.1186/s40064-016-2437-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 05/27/2016] [Indexed: 11/17/2022]
Abstract
Objectives To perform a systematic review and meta-analysis of the efficacy and safety of permissive hypercapnia in extremely low birth weight infants. Methods A systematic search of MEDLINE, EMBASE, the Cochrane Database of randomized trials. Eligibility and quality of trials were assessed, and data on study design, patient characteristics, and relevant outcomes were extracted. Results Four studies that enrolled a total of 693 participants were selected. Meta-analysis revealed no effect of permissive hypercapnia on decreasing rates of bronchopulmonary dysplasia (BPD). Permissive hypercapnia also had no significant effect on mortality, intraventricular haemorrhage (IVH), IVH (grade 3–4), periventricular leukomalacia (PVL), necrotising enterocolitis (NEC), retinopathy of prematurity (ROP) or air leaks in extremely low birth weight infants. Neurodevelopmental outcomes were comparable at 18–22 months’ corrected age in two studies. permissive hypercapnia did not increase the risk of cerebral palsy, Mental Developmental Index <70, Psychomotor Developmental Index <70, visual deficit, or hearing deficit. Conclusions Permissive hypercapnia did not reduce the rate of BPD in extremely low birth weight infants. The rates of mortality, IVH, PVL, NEC, ROP and neurodevelopmental outcomes did not differ between these two groups. These results suggest that permissive hypercapnia does not bring extra benefits in extremely low birth weight infants.
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Affiliation(s)
- Jianglin Ma
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310000 People's Republic of China
| | - Hui Ye
- Department of Pediatrics, Taizhou First People's Hospital, Taizhou, 318020 People's Republic of China
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19
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The outcomes of children with pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015; 16:S118-31. [PMID: 26035362 DOI: 10.1097/pcc.0000000000000438] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To provide additional details and evidence behind the recommendations for outcomes assessment of patients with pediatric acute respiratory distress syndrome from the Pediatric Acute Lung Injury Consensus Conference. DESIGN Consensus conference of experts in pediatric acute lung injury. METHODS A panel of 27 experts met over the course of 2 years to develop a taxonomy to define pediatric acute respiratory distress syndrome and to make recommendations regarding treatment and research priorities. The outcomes subgroup comprised four experts. When published data were lacking, a modified Delphi approach emphasizing strong professional agreement was used. RESULTS The Pediatric Acute Lung Injury Consensus Conference experts developed and voted on a total of 151 recommendations addressing the topics related to pediatric acute respiratory distress syndrome, seven of which related to outcomes after pediatric acute respiratory distress syndrome. All seven recommendations had strong agreement. Children with acute respiratory distress syndrome continue to have a high mortality, specifically, in relation to certain comorbidities and etiologies related to pediatric acute respiratory distress syndrome. Comorbid conditions, such as an immunocompromised state, increase the risk of mortality even further. Likewise, certain etiologies, such as non-pulmonary sepsis, also place children at a higher risk of mortality. Significant long-term effects were reported in adult survivors of acute respiratory distress syndrome: diminished lung function and exercise tolerance, reduced quality of life, and diminished neurocognitive function. Little knowledge of long-term outcomes exists in children who survive pediatric acute respiratory distress syndrome. Characterization of the longer term consequences of pediatric acute respiratory distress syndrome in children is vital to help identify opportunities for improved therapeutic and rehabilitative strategies that will lessen the long-term burden of pediatric acute respiratory distress syndrome and improve the quality of life in children. CONCLUSIONS The Consensus Conference developed pediatric-specific recommendations for pediatric acute respiratory distress syndrome regarding outcome measures and future research priorities. These recommendations are intended to promote optimization and consistency of care for children with pediatric acute respiratory distress syndrome and identify areas of uncertainty requiring further investigation.
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Engelhardt E, Inder TE, Alexopoulos D, Dierker DL, Hill J, Van Essen D, Neil JJ. Regional impairments of cortical folding in premature infants. Ann Neurol 2014; 77:154-62. [PMID: 25425403 PMCID: PMC4324979 DOI: 10.1002/ana.24313] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 11/14/2014] [Accepted: 11/17/2014] [Indexed: 11/28/2022]
Abstract
Objective This study was undertaken to evaluate the influence of preterm birth and other factors on cerebral cortical maturation. Methods We have evaluated the effects of preterm birth on cortical folding by applying cortical cartography methods to a cohort of 52 preterm infants (<31 weeks gestation, mild or no injury on conventional magnetic resonance imaging) and 12 term-born control infants. All infants were evaluated at term-equivalent postmenstrual age. Results Preterm infants had lower values for the global measures of gyrification index (GI; 2.06 ± 0.07 vs 1.80 ± 0.12, p < 0.001; control vs preterm) and cortical surface area (CSA; 316 ± 24 cm2 vs 257 ± 40 cm2, p < 0.001). Regional analysis of sulcal depth and cortical shape showed the greatest impact of preterm birth on the insula, superior temporal sulcus, and ventral portions of the pre- and postcentral sulci in both hemispheres. Although CSA and GI are related, CSA was more sensitive to antenatal and postnatal factors than GI. Both measures were lower in preterm infants of lower birth weight standard deviation scores and smaller occipitofrontal circumference at time of scan, whereas CSA alone was lower in association with smaller occipitofrontal circumference at birth. CSA was also lower in infants with higher critical illness in the first 24 hours of life, exposure to postnatal steroids, and prolonged endotracheal intubation. Interpretation Preterm birth disrupts cortical development in a regionally specific fashion with abnormalities evident by term-equivalent postmenstrual age. This disruption is influenced by both antenatal growth and postnatal course.
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21
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Lundequist A, Böhm B, Smedler AC. Individual neuropsychological profiles at age 5½ years in children born preterm in relation to medical risk factors. Child Neuropsychol 2013; 19:313-31. [PMID: 22384932 DOI: 10.1080/09297049.2011.653331] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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22
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Score for neonatal acute physiology-II and neonatal pain predict corticospinal tract development in premature newborns. Pediatr Neurol 2013; 48:123-129.e1. [PMID: 23337005 PMCID: PMC4489879 DOI: 10.1016/j.pediatrneurol.2012.10.016] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 10/29/2012] [Indexed: 10/27/2022]
Abstract
Premature infants are at risk for adverse motor outcomes, including cerebral palsy and developmental coordination disorder. The purpose of this study was to examine the relationship of antenatal, perinatal, and postnatal risk factors for abnormal development of the corticospinal tract, the major voluntary motor pathway, during the neonatal period. In a prospective cohort study, 126 premature neonates (24-32 weeks' gestational age) underwent serial brain imaging near birth and at term-equivalent age. With diffusion tensor tractography, mean diffusivity and fractional anisotropy of the corticospinal tract were measured to reflect microstructural development. Generalized estimating equation models examined associations of risk factors on corticospinal tract development. The perinatal risk factor of greater early illness severity (as measured by the Score for Neonatal Acute Physiology-II [SNAP-II]) was associated with a slower rise in fractional anisotropy of the corticospinal tract (P = 0.02), even after correcting for gestational age at birth and postnatal risk factors (P = 0.009). Consistent with previous findings, neonatal pain adjusted for morphine and postnatal infection were also associated with a slower rise in fractional anisotropy of the corticospinal tract (P = 0.03 and 0.02, respectively). Lessening illness severity in the first hours of life might offer potential to improve motor pathway development in premature newborns.
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Abstract
Although significant advances in respiratory care have been made in neonatal medicine, bronchopulmonary dysplasia (BPD) remains the most common serious pulmonary morbidity in premature infants. The development of BPD is the result of the complex interactions between multiple perinatal and postnatal factors. Early identification of infants at the most risk of developing BPD through the use of estimators and models may allow a targeted approach at reducing BPD in the future.
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Affiliation(s)
- Andrea Trembath
- Rainbow Babies & Children's Hospital, 11000 Euclid Avenue, RBC Suite 3100, Cleveland, OH 44106, USA.
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24
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Massie SE, Tolleson-Rinehart S, DeWalt DA, Laughon MM, Powell LM, Price WA. Development of a proxy-reported pulmonary outcome scale for preterm infants with bronchopulmonary dysplasia. Health Qual Life Outcomes 2011; 9:55. [PMID: 21791099 PMCID: PMC3161834 DOI: 10.1186/1477-7525-9-55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 07/26/2011] [Indexed: 11/12/2022] Open
Abstract
Background To develop an accurate, proxy-reported bedside measurement tool for assessment of the severity of bronchopulmonary dysplasia (also called chronic lung disease) in preterm infants to supplement providers' current biometric measurements of the disease. Methods We adapted Patient-Reported Outcomes Measurement Information System (PROMIS) methodology to develop the Proxy-Reported Pulmonary Outcomes Scale (PRPOS). A multidisciplinary group of registered nurses, nurse practitioners, neonatologists, developmental specialists, and feeding specialists at five academic medical centers participated in the PRPOS development, which included five phases: (1) identification of domains, items, and responses; (2) item classification and selection using a modified Delphi process; (3) focus group exploration of items and response options; (4) cognitive interviews on a preliminary scale; and (5) final revision before field testing. Results Each phase of the process helped us to identify, classify, review, and revise possible domains, questions, and response options. The final items for field testing include 26 questions or observations that a nurse assesses before, during, and after routine care time and feeding. Conclusions We successfully created a prototype scale using modified PROMIS methodology. This process can serve as a model for the development of proxy-reported outcomes scales in other pediatric populations.
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Affiliation(s)
- Sara E Massie
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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25
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Laughon MM, Langer JC, Bose CL, Smith PB, Ambalavanan N, Kennedy KA, Stoll BJ, Buchter S, Laptook AR, Ehrenkranz RA, Cotten CM, Wilson-Costello DE, Shankaran S, Van Meurs KP, Davis AS, Gantz MG, Finer NN, Yoder BA, Faix RG, Carlo WA, Schibler KR, Newman NS, Rich W, Das A, Higgins RD, Walsh MC. Prediction of bronchopulmonary dysplasia by postnatal age in extremely premature infants. Am J Respir Crit Care Med 2011; 183:1715-22. [PMID: 21471086 DOI: 10.1164/rccm.201101-0055oc] [Citation(s) in RCA: 309] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Benefits of identifying risk factors for bronchopulmonary dysplasia in extremely premature infants include providing prognostic information, identifying infants likely to benefit from preventive strategies, and stratifying infants for clinical trial enrollment. OBJECTIVES To identify risk factors for bronchopulmonary dysplasia, and the competing outcome of death, by postnatal day; to identify which risk factors improve prediction; and to develop a Web-based estimator using readily available clinical information to predict risk of bronchopulmonary dysplasia or death. METHODS We assessed infants of 23-30 weeks' gestation born in 17 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network and enrolled in the Neonatal Research Network Benchmarking Trial from 2000-2004. MEASUREMENTS AND MAIN RESULTS Bronchopulmonary dysplasia was defined as a categorical variable (none, mild, moderate, or severe). We developed and validated models for bronchopulmonary dysplasia risk at six postnatal ages using gestational age, birth weight, race and ethnicity, sex, respiratory support, and Fi(O(2)), and examined the models using a C statistic (area under the curve). A total of 3,636 infants were eligible for this study. Prediction improved with advancing postnatal age, increasing from a C statistic of 0.793 on Day 1 to a maximum of 0.854 on Day 28. On Postnatal Days 1 and 3, gestational age best improved outcome prediction; on Postnatal Days 7, 14, 21, and 28, type of respiratory support did so. A Web-based model providing predicted estimates for bronchopulmonary dysplasia by postnatal day is available at https://neonatal.rti.org. CONCLUSIONS The probability of bronchopulmonary dysplasia in extremely premature infants can be determined accurately using a limited amount of readily available clinical information.
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Affiliation(s)
- Matthew M Laughon
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina 27599-7596, USA.
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Neuromotor outcomes in infants with bronchopulmonary dysplasia. Pediatr Neurol 2011; 44:40-6. [PMID: 21147386 DOI: 10.1016/j.pediatrneurol.2010.07.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 03/04/2010] [Accepted: 07/21/2010] [Indexed: 11/22/2022]
Abstract
We examine the neuromotor outcomes of preterm infants with bronchopulmonary dysplasia. Two hundred and nineteen infants (gestational age, ≤ 32 weeks; birth weight, ≤ 1500 g) were studied. Neuromotor development was assessed using the Hammersmith Infant Neurological Examination. All potential risk factors associated with neuromotor scores (P < 0.015) were included in the generalized linear model (multiple linear regression) to determine if bronchopulmonary dysplasia had an independent relationship with neuromotor scores. Infants with severe bronchopulmonary dysplasia had lower global scores at ages 6 and 12 months. After adjustment for confounding factors, scores of infants with severe bronchopulmonary dysplasia were reduced by 13.2 units, whereas scores for those with periventricular leukomalacia were reduced by 11.1 units, at age 6 months. At age 12 months, scores for those with periventricular leukomalacia were reduced by 11.9 units. Duration of hospital stay reduced scores by 0.1 for each additional day increase in hospital. Bronchopulmonary dysplasia constitutes a major cause of poor neuromotor outcomes at age 6 months, but improvements in motor outcomes occur over time.
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Marín Gabriel MA, Bergón Sendín E, Melgar Bonís A, García Lara N, Rosa Pallás Alonso C, de la Cruz Bértolo J. [Ages of sitting up and walking in preterm newborns less than 1,500 G with bronchopulmonary dysplasia]. An Pediatr (Barc) 2010; 74:84-90. [PMID: 21169075 DOI: 10.1016/j.anpedi.2010.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 08/10/2010] [Accepted: 09/19/2010] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Adverse neurological events in very low birth weight (VLBW) children with bronchopulmonary dysplasia (BPD) are more frequent than in children without. An understanding of the ages when preterm infants acquire certain motor skills will give parents more appropriate information on motor development. The objective of the present study is to estimate the influence between BPD and the age of acquisition of sitting unsupported and independent walking in VLBW children with normal neurological examination at 2 years of corrected age. PATIENTS AND METHODS A longitudinal study was conducted on a cohort of 885 children with VLBW, admitted to the Hospital "12 de Octubre" between January 1991 and December 2003. Age for both skills was established by interview with parents. Means were compared with t-test and Bonferroni adjustment where appropriate. RESULTS Both motor skills were acquired later in the group with BPD (7.8±2m vs. 7.1±1.3m for sitting unsupported and 14.5±3.8m vs. 13.4±2.5m for walking) (P<.001). BPD was associated with delayed acquisition (above p90) of these skills, OR=2.6 (1.6-4.1) for sitting and OR=2.8 (1.6-4.8) for walking. Association was found after adjusting for gestational age (GA) and weight. CONCLUSION BPD was associated with delayed acquisition of both skills in VLBW children with normal neurological examination at 2 years.
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Affiliation(s)
- M A Marín Gabriel
- Departamento de Neonatología, Hospital Universitario 12 de Octubre, Madrid, Spain
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Cools F, Askie LM, Offringa M, Asselin JM, Calvert SA, Courtney SE, Dani C, Durand DJ, Gerstmann DR, Henderson-Smart DJ, Marlow N, Peacock JL, Pillow JJ, Soll RF, Thome UH, Truffert P, Schreiber MD, Van Reempts P, Vendettuoli V, Vento G. Elective high-frequency oscillatory versus conventional ventilation in preterm infants: a systematic review and meta-analysis of individual patients' data. Lancet 2010; 375:2082-91. [PMID: 20552718 DOI: 10.1016/s0140-6736(10)60278-4] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Population and study design heterogeneity has confounded previous meta-analyses, leading to uncertainty about effectiveness and safety of elective high-frequency oscillatory ventilation (HFOV) in preterm infants. We assessed effectiveness of elective HFOV versus conventional ventilation in this group. METHODS We did a systematic review and meta-analysis of individual patients' data from 3229 participants in ten randomised controlled trials, with the primary outcomes of death or bronchopulmonary dysplasia at 36 weeks' postmenstrual age, death or severe adverse neurological event, or any of these outcomes. FINDINGS For infants ventilated with HFOV, the relative risk of death or bronchopulmonary dysplasia at 36 weeks' postmenstrual age was 0.95 (95% CI 0.88-1.03), of death or severe adverse neurological event 1.00 (0.88-1.13), or any of these outcomes 0.98 (0.91-1.05). No subgroup of infants (eg, gestational age, birthweight for gestation, initial lung disease severity, or exposure to antenatal corticosteroids) benefited more or less from HFOV. Ventilator type or ventilation strategy did not change the overall treatment effect. INTERPRETATION HFOV seems equally effective to conventional ventilation in preterm infants. Our results do not support selection of preterm infants for HFOV on the basis of gestational age, birthweight for gestation, initial lung disease severity, or exposure to antenatal corticosteroids. FUNDING Nestlé Belgium, Belgian Red Cross, and Dräger International.
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Affiliation(s)
- Filip Cools
- Neonatal Intensive Care Unit, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
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Differences in impaired brainstem conduction between neonatal chronic lung disease and perinatal asphyxia. Clin Neurophysiol 2010; 121:725-33. [PMID: 20097607 DOI: 10.1016/j.clinph.2009.12.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 11/06/2009] [Accepted: 12/08/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To explore any differences in impaired brainstem function between preterm infants with neonatal chronic lung disease (CLD) and term infants after perinatal asphyxia. METHODS Brainstem auditory evoked responses (BAERs) collected using maximum length sequence (MLS) technique were compared at term equivalent age between 43 CLD infants and 117 asphyxiated infants. RESULTS In both CLD and asphyxiated infants there was a significant increase in wave V latency and I-V interval in MLS BAER. CLD infants showed a significant increased III-V interval but a normal I-III interval at all click rates. However, asphyxiated infants showed a significant increase in both III-V and I-III intervals. I-III interval was shorter and III-V/I-III interval ratio was greater in CLD infants than in asphyxiated infants. The slope of I-III interval-rate function was steeper in asphyxiated infants than in CLD infants, while the slope of III-V/I-III interval ratio-rate function was the other way around. CONCLUSIONS CLD infants had a major increase in more central components of MLS BAER, without appreciable abnormality in more peripheral components. However, asphyxiated infants had a significant increase in both central and peripheral components. SIGNIFICANCE Neonatal CLD affects more central regions of the brainstem, whereas perinatal asphyxia affects both peripheral and central regions. This difference, which is likely related to the different nature of hypoxia in CLD and asphyxia, may have some significance for neuroprotective interventions for the two problems.
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Abstract
Staff may be reluctant to discuss end of life decisions in chronic lung disease (CLD) as it is usual for the disease to take a prolonged course and most infants recover to be discharged home without supplemental oxygen. A minority suffer a protracted and very severe illness in spite of treatments. Further intensive care may prolong a distressing death rather than offer any hope of survival. An end of life decision may be made after discussions with parents. Assisted ventilation may be withdrawn, or care redirected to withhold further episodes of assisted ventilation. A lingering death is a risk in infants who have not yet reached the point of dying but whose care has been redirected. Tachypnoea, rib retractions and agitation are distressing for the infant and parents. Palliative care must meet the needs of parents as well as their baby. It includes the legal use of drugs to relieve the infant's distress.
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Affiliation(s)
- Malcolm Chiswick
- University of Manchester, and Saint Mary's Hospital, Manchester, UK.
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Abstract
Preterm birth is an event that affects the child's healthy development. Several studies have addressed the evaluation of children born preterm and the influence that multiple risk factors have on the course of their development. This study performed a systematic review of the literature from 2000 to 2005 about the evaluation of the development of children born preterm until the age of 24 months. The biological risk factors were present in every study, with highlights on intraventricular hemorrhage, necrotizing enterocolitis, chronic pulmonary disease, and retardation of intrauterine development as the most studied risks. The child's motor development was the most studied area. In terms of age, the first evaluations focused on the first six months of life. Neonatal risk, low birth weight, baby boys, cerebral injuries, and first-week abnormal spontaneous movements were predicting factors of preterm child development at the age of two years.
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Souza TGD, Stopíglia MS, Baracat ECE. Avaliação neurológica de recém-nascidos pré-termo de muito baixo peso com displasia broncopulmonar. REVISTA PAULISTA DE PEDIATRIA 2009. [DOI: 10.1590/s0103-05822009000100004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Descrever e comparar a avaliação neurológica e comportamental de recém-nascidos pré-termos com e sem displasia broncopulmonar (DBP). MÉTODOS: Recém-nascidos prematuros com peso ao nascer inferior a 1500g e idade gestacional menor de 32 semanas foram avaliados com 40 semanas de idade gestacional corrigida, no Centro de Atenção Integral à Saúde da Mulher da Universidade Estadual de Campinas. Utilizou-se a Avaliação Neurológica de Dubowitz, com 29 itens divididos em seis categorias: tônus, padrões de tônus, reflexos, movimentos, sinais anormais e comportamento. O estado de consciência do recém-nascido foi graduado segundo Brazelton (1973). Utilizaram-se os testes do qui-quadrado e exato de Fischer para variáveis qualitativas e o de Mann-Whitney para as numéricas não-paramétricas, com nível de significância de 5%. RESULTADOS: No período de janeiro de 2005 a setembro de 2007, 24 recém-nascidos, 12 com DBP e 12 controles, com idade gestacional ao nascer de 28±1 semana e peso de 884±202g no grupo com DBP e 31±1 semana e 1156±216g no Grupo Controle foram avaliados. Dos 29 itens avaliados, 18 foram homogêneos entre os grupos e a pontuação geral dos dois grupos não apresentou diferença (p=0,30). Observou-se maior anormalidade neurológica no grupo com DBP em oito itens e, no Grupo Controle, em três itens. CONCLUSÕES: A comparação da avaliação neurológica de Dubowitz de recém-nascidos pré-termos com e sem DBP não apresentou diferença significante com 40 semanas de idade gestacional corrigida. Nas categorias reflexos e postura/tônus, observou-se tendência a anormalidade no grupo DBP.
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Jeng SF, Hsu CH, Tsao PN, Chou HC, Lee WT, Kao HA, Hung HY, Chang JH, Chiu NC, Hsieh WS. Bronchopulmonary dysplasia predicts adverse developmental and clinical outcomes in very-low-birthweight infants. Dev Med Child Neurol 2008; 50:51-7. [PMID: 18173631 DOI: 10.1111/j.1469-8749.2007.02011.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study examined the developmental and clinical outcomes in very-low-birthweight (VLBW; < or =1500g) infants with and without bronchopulmonary dysplasia (BPD) throughout infancy, and assessed if BPD predicted poor developmental outcome beyond the effects of other risk factors. One hundred and three VLBW infants (53 males, 50 females; mean gestational age 28wks [SD 2] birthweight 1041g [SD 261]) were graded for severity of BPD according to the American National Institutes of Health (NIH) consensus definition. Neuro-development was assessed using the Neonatal Neurobehavioral Examination-Chinese version, at 36 and 39 weeks' postmenstrual age, and the 2nd edition of the Bayley Scales of Infant Development at 6 and 12 months' corrected age. Clinical outcome was measured by means of rehospitalization for pulmonary causes and treatment with pulmonary medications. Compared with infants without BPD, infants with BPD had higher rates of clinical morbidity, and those with severe BPD further exhibited higher incidences of developmental delay throughout infancy. BPD predicts poor 1-year developmental and clinical outcomes in VLBW infants for which effects are well correlated to the NIH consensus definition.
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Affiliation(s)
- Suh-Fang Jeng
- School of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
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34
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Wilkinson AR, Brosi DM, Jiang ZD. Functional impairment of the brainstem in infants with bronchopulmonary dysplasia. Pediatrics 2007; 120:362-71. [PMID: 17671063 DOI: 10.1542/peds.2006-3685] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To gain new insights into the influence of bronchopulmonary dysplasia on the immature brain and to detect abnormalities, we studied the functional integrity of the brainstem in infants with bronchopulmonary dysplasia. METHODS Forty-one very preterm infants with bronchopulmonary dysplasia were studied at postconceptional ages of 37 to 42 weeks. Brainstem auditory evoked responses were recorded and analyzed by using the maximal length sequence technique. RESULTS Compared with term control subjects, wave V latency in the maximal length sequence brainstem auditory evoked response of the infants with bronchopulmonary dysplasia increased significantly at all 91 to 910 clicks per second rates. Similarly, I-V and particularly III-V interpeak intervals increased significantly. The III-V/I-III interval ratio also increased significantly at all click rates. All of these abnormalities became more significant as the click rate was increased. Compared with healthy, very preterm control subjects, all of these maximal length sequence brainstem auditory evoked response variables increased significantly at all click rates, although the differences between the 2 groups were slightly smaller than those between the infants with bronchopulmonary dysplasia and the term control subjects. The wave I and III latencies and I-III interval in the infants with bronchopulmonary dysplasia did not show any abnormalities. The slopes of the wave V latency-rate function and I-V and particularly III-V interval-rate functions for the infants with bronchopulmonary dysplasia were significantly steeper than those for both term and healthy, very preterm control subjects. The slope of the III-V/I-III interval ratio-rate function for the infants with bronchopulmonary dysplasia was also significantly steeper than those for the 2 control groups. CONCLUSIONS The results suggest poor myelination and synaptic function of the brainstem in infants with bronchopulmonary dysplasia, resulting in impaired functional integrity. In comparison, peripheral neural function was relatively intact.
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Affiliation(s)
- Andrew R Wilkinson
- Neonatal Unit, Department of Paediatrics, John Radcliffe Hospital, Headington, Oxford OX3 9DU, United Kingdom
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35
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Jiang ZD, Yin R, Wilkinson AR. Brainstem auditory evoked responses in very low birthweight infants with chronic lung disease. Eur J Paediatr Neurol 2007; 11:153-9. [PMID: 17276109 DOI: 10.1016/j.ejpn.2006.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 09/25/2006] [Accepted: 12/05/2006] [Indexed: 11/19/2022]
Abstract
UNLABELLED Very low birthweight (VLBW) infants who had prolonged oxygen dependence due to chronic respiratory problems, typically neonatal chronic lung disease (CLD), are at high risk of neurodevelopmental impairment. To assess the effect of CLD on neonatal auditory function we studied brainstem auditory evoked response (BAER) in VLBW infants who suffered CLD but no other major perinatal complications or problems. At 37-42 week postconceptional age, the latencies of waves I, III and V in CLD infants were all significantly longer than in normal term infants (all p<0.001). The differences between CLD infants and the term controls were greater for the later waves than for the earlier waves. Abnormally prolonged wave latency (>2.5 SD of the mean measurement) was seen in 7 (21.2%) CLD infants for wave I, suggesting peripheral auditory impairment, 8 (24.2%) for wave III and 14 (42.4%) for wave V. I-V interval in CLD infants was significantly longer than in the term controls (p<0.001). Seven (21.2%) infants had abnormally prolonged I-V interval, suggesting brainstem or central auditory impairment. Of these infants, 2 had both prolonged wave latencies and prolonged I-V interval, suggesting both peripheral and central auditory impairment. Similar abnormalities were found in CLD infants when compared with the BAER in birthweight- and age-matched healthy VLBW infants without CLD. CONCLUSION Neonatal auditory function is impaired, both peripherally and centrally, at term age in VLBW infants who suffer neonatal CLD.
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Affiliation(s)
- Ze D Jiang
- Children's Hospital, Shanghai Medical University, Shanghai, China.
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36
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Moon NM, Mohay HA, Gray PH. Developmental patterns from 1 to 4 years of extremely preterm infants who required home oxygen therapy. Early Hum Dev 2007; 83:209-16. [PMID: 16860947 DOI: 10.1016/j.earlhumdev.2006.05.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2006] [Revised: 05/15/2006] [Accepted: 05/22/2006] [Indexed: 12/01/2022]
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) remains a common complication of prematurity, with those being discharged on home oxygen at particularly high risk of adverse developmental outcomes. AIMS To compare the developmental patterns, from 1 to 4 years, of extremely preterm infants with BPD discharged from hospital on home oxygen, extremely preterm infants with BPD discharged breathing room air, and extremely preterm infants without BPD. SUBJECTS Two hundred and seventy-six infants with a gestational age of <28 weeks or birthweight <1000 g, free from sensory and motor disabilities who were followed up longitudinally to 4 years corrected age. OUTCOME MEASURES Children were assessed on the Griffiths Mental Development Scales at 1 and 2 years corrected age, and the McCarthy Scales of Children's Abilities at 4 years corrected age. RESULTS The developmental trajectories of the three groups did not differ significantly, however at 1 year corrected age the non-BPD group had significantly higher developmental scores than both BPD groups. At 2 years corrected age the non-BPD group had significantly higher developmental scores than the BPD-home oxygen group, and at 4 years corrected age no differences between the groups were evident. CONCLUSIONS Extremely preterm children with BPD exhibited an initial developmental lag compared to preterm peers. Children with BPD discharged breathing room air had developmental scores at 2 years corrected age that were comparable to the non-BPD group, but those discharged on home oxygen still had lower developmental scores. At 4 years, no differences between the groups were evident.
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Affiliation(s)
- Natasha M Moon
- Queensland University of Technology, School of Psychology and Counselling, Beams Road Carseldine, Qld. 4034, Australia.
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37
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De Kleine MJK, Nijhuis-Van Der Sanden MWG, Lya Den Ouden A. Is paediatric assessment of motor development of very preterm and low-birthweight children appropriate? Acta Paediatr 2006; 95:1202-8. [PMID: 16982490 DOI: 10.1080/08035250500525301] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM To determine whether paediatricians that examine, in regular clinical practice, very preterm and very-low-birthweight children at 5 y of age detect neurological impairments and functional motor problems in these children. METHODS We compared a paediatric judgement, a standardized neurological examination (Touwen examination) and a screening of motor development (Denver Developmental Screening Test; DDST) with the Movement ABC in 396 5-y-old very preterm and low-birthweight children. RESULTS The Movement ABC detected clinically important motor disorders in 20.5% and borderline disturbances in 22.5% of the children. Compared to the Movement ABC, the sensitivity of the paediatric judgement was 0.19, Touwen examination 0.62 and DDST 0.52; the negative predictive values were 0.61, 0.74 and 0.69, respectively. CONCLUSION Paediatric assessment of motor development in 5-y-old very preterm and low-birthweight children generally is not sensitive enough to detect functional motor problems. The Movement ABC should be added to the assessment of the motor development of very preterm and low-birthweight children at 5 y of age.
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Raman L, Georgieff MK, Rao R. The role of chronic hypoxia in the development of neurocognitive abnormalities in preterm infants with bronchopulmonary dysplasia. Dev Sci 2006; 9:359-67. [PMID: 16764609 DOI: 10.1111/j.1467-7687.2006.00500.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Bronchopulmonary dysplasia is the most common pulmonary morbidity in preterm infants and is associated with chronic hypoxia. Animal studies have demonstrated structural, neurochemical and functional alterations due to chronic hypoxia in the developing brain. Long-term impairments in visual-motor, gross and fine motor, articulation, reading, mathematics, spatial memory and attention skills are prevalent in survivors of bronchopulmonary dysplasia, and impairments appear to correlate with the severity of hypoxia. However, due to the simultaneous occurrence of multiple neurodevelopmental risk factors, a primary or potentiating role for chronic hypoxia in these impairments has yet to be conclusively established.
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Affiliation(s)
- Lakshmi Raman
- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, MN, USA
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39
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Jiang ZD, Brosi DM, Wilkinson AR. Brain-stem auditory function in very preterm infants with chronic lung disease: Delayed neural conduction. Clin Neurophysiol 2006; 117:1551-9. [PMID: 16759903 DOI: 10.1016/j.clinph.2006.04.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Revised: 04/21/2006] [Accepted: 04/25/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine brain-stem auditory function at term in very preterm infants who suffered chronic lung disease (CLD). METHODS Brain-stem auditory evoked response (BAER) was recorded at term with clicks in 25 very preterm infants with CLD and no concomitant other major perinatal problems. RESULTS Compared to those in normal term controls, BAER wave V latency and I-V and III-V interpeak intervals in the CLD infants increased significantly (ANOVA P<0.01-0.001). III-V/I-III interval ratio also increased significantly (P<0.01). The latencies of waves I and III did not differ significantly from the controls. However, no abnormalities were found in BAER wave amplitudes. These BAER findings, obtained at 21/s clicks, were also seen at the rates 51 and 91/s, although the increase in III-V interval tended to be more significant. Click rate-dependent changes in BAER variables in the CLD infants were generally similar to the controls, with slight differences. CONCLUSIONS BAER components, mainly reflecting central auditory function, increased significantly. The increase in wave V latency and I-V interval is due to the increase in III-V interval. SIGNIFICANCE Neural conduction in the more central portion of the brain-stem auditory pathway is delayed and thus brain-stem auditory function is impaired in CLD infants.
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Affiliation(s)
- Ze D Jiang
- Children's Hospital, Shanghai Medical University, Shanghai, China.
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Volgmann T, Ohlinger R, Panzig B. Ureaplasma urealyticum-harmless commensal or underestimated enemy of human reproduction? A review. Arch Gynecol Obstet 2005; 273:133-9. [PMID: 16044191 DOI: 10.1007/s00404-005-0030-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2005] [Accepted: 04/28/2005] [Indexed: 11/26/2022]
Abstract
This article reviews the role, diagnosis and treatment of Ureaplasma infections in human reproduction.
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Affiliation(s)
- Thorsten Volgmann
- Department of Gynaecology and Obstetrics of the Ernst Moritz Arndt University, Wollweberstrasse 1, 17487, Greifswald, Germany.
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Hintz SR, Kendrick DE, Vohr BR, Poole WK, Higgins RD. Changes in neurodevelopmental outcomes at 18 to 22 months' corrected age among infants of less than 25 weeks' gestational age born in 1993-1999. Pediatrics 2005; 115:1645-51. [PMID: 15930228 DOI: 10.1542/peds.2004-2215] [Citation(s) in RCA: 178] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Increased survival rates for extremely preterm, extremely low birth weight infants during the postsurfactant era have been reported, but data on changes in neurosensory and developmental impairments are sparse. OBJECTIVE To compare neuromotor and neurodevelopmental outcomes at 18 to 22 months' corrected age for infants of <25 weeks' estimated gestational age (EGA) who were born in the 1990s. METHODS This was a multicenter, retrospective, comparative analysis of infants of <25 weeks' EGA, with birth weights of 501 to 1000 g, born between January 1993 and June 1996 (epoch I) or between July 1996 and December 1999 (epoch II), in the National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental assessments were performed at 18 to 22 months' corrected age. Logistic-regression models were constructed to evaluate the independent risk of cerebral palsy, Mental Development Index of <70, Psychomotor Development Index of <70, and neurodevelopmental impairment. RESULTS A total of 366 patients in epoch I and 473 patients in epoch II were evaluated. Prenatal steroid use, cesarean section, surfactant treatment, bronchopulmonary dysplasia, and severe retinopathy of prematurity were more likely in epoch II, whereas Apgar scores of <5 at 5 minutes, patent ductus arteriosus, and severe intraventricular hemorrhage were more likely in epoch I. The prevalences of cerebral palsy, Psychomotor Development Index of <70, and neurodevelopmental impairment were similar between epochs. The prevalences of Mental Development Index of <70 were 40% for epoch I and 47% for epoch II. Regression analysis revealed that epoch II was an independent risk factor for Mental Developmental Index of <70 (epoch I versus II: odds ratio: 0.63; 95% confidence interval: 0.45-0.87) but not for other outcomes. CONCLUSIONS Early childhood neurodevelopmental outcomes among infants of <25 weeks' EGA are not improving in the postsurfactant era, despite more aggressive perinatal and neonatal treatment. Later childhood follow-up assessment is needed to delineate trends in severe cognitive impairment in this extremely high-risk group.
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Affiliation(s)
- Susan R Hintz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, 750 Welch Rd, Suite 315, Palo Alto, CA 94304, USA.
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Laptook AR, O'Shea TM, Shankaran S, Bhaskar B. Adverse neurodevelopmental outcomes among extremely low birth weight infants with a normal head ultrasound: prevalence and antecedents. Pediatrics 2005; 115:673-80. [PMID: 15741371 DOI: 10.1542/peds.2004-0667] [Citation(s) in RCA: 198] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Severe abnormalities of the head ultrasound (HUS) are important predictors of cerebral palsy (CP) and mental retardation, and a normal HUS usually ensures the absence of major impairments. With the increasing survival of extremely low birth weight (ELBW) infants (birth weight <1000 g), the prognostic significance of a normal HUS may differ. This study examined the prevalence of and risk factors for CP and impaired mental development among ELBW infants with a normal HUS. METHODS Study infants were ELBW infants who were cared for in Neonatal Research Network centers in the years 1995-1999, had a normal early and late HUS, survived to discharge, and returned for follow-up assessments at 18 to 22 months' corrected age. The outcomes of interest were a score <70 on the Bayley Scales of Infant Development-II Mental Developmental Index (MDI) and CP. Risk factors included maternal demographics; infant characteristics; and interventions or morbidities related to the lung, infection, and nutrition. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). A time-oriented approach was used to select variables for inclusion in logistic models. RESULTS Of 1749 infants with a normal early and late HUS (performed at a mean age of 6 and 47 days, respectively), 1473 (84%) returned for follow-up assessment. Infants had a birth weight of 792 +/- 134 g (mean +/- SD) and gestational age of 26 +/- 2 weeks. Rates of CP and MDI <70 were 9.4% and 25.3%, respectively, and 29.2% of infants had either CP or MDI <70. In multivariate analyses, factors associated with CP were male gender (OR: 1.8; 95% CI: 1.2-2.6), multiple birth, (OR: 1.6; 95% CI: 1.1-2.5), decreasing birth weight (OR: 1.3 for each 100-g decrease; 95% CI: 1.1-1.5), pneumothorax (OR: 2.3; 95% CI: 1.2-4.4), and days of conventional ventilation (OR: 1.2 for each additional 10 days; 95% CI: 1.1-1.3). With the exception of pneumothorax, these same factors were associated with MDI <70, in addition to less maternal education (OR: 1.4; 95% CI: 1.0-1.9) and Medicaid or lack of coverage for maternal insurance (OR: 1.7; 95% CI: 1.2-2.4). CONCLUSIONS Nearly 30% of ELBW infants with a normal HUS had either CP or a low MDI. Risk factors that are associated with this high rate of adverse outcomes include pneumothorax, prolonged exposure to mechanical ventilation, and educational and economic disadvantage. Improvements in pulmonary care to reduce duration of ventilation and avoid air leaks might improve neurodevelopmental outcome for ELBW infants.
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Wood NS, Costeloe K, Gibson AT, Hennessy EM, Marlow N, Wilkinson AR. The EPICure study: associations and antecedents of neurological and developmental disability at 30 months of age following extremely preterm birth. Arch Dis Child Fetal Neonatal Ed 2005; 90:F134-40. [PMID: 15724037 PMCID: PMC1721849 DOI: 10.1136/adc.2004.052407] [Citation(s) in RCA: 280] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To describe perinatal factors associated with later morbidity among extremely preterm children at 30 months of age corrected for prematurity. POPULATION Of 308 surviving children born at <or=25 weeks gestation in the United Kingdom and Ireland from March to December 1995, 283 (92%) were evaluated at 30 months of age corrected for prematurity. METHODS Cerebral palsy, severe motor disability, and Bayley scores were used as dependent variables in sequential multiple regression analyses to identify factors associated with adverse outcomes. RESULTS Adverse outcomes were consistently more common in boys. Factors related to perinatal illness, ultrasound evidence of brain injury, and treatment (particularly postnatal steroids) were associated with adverse motor outcomes (cerebral palsy, disability or Bayley psychomotor development index). Increasing duration of postnatal steroid treatment was associated with poor motor outcomes. A score was developed for severe motor disability with good negative predictive value. In contrast, mental development was associated with a broader range of factors: ethnic group, maternal educational level, the use of antenatal steroids, and prolonged rupture of membranes in addition to chronic lung disease. CONCLUSION Male sex is a pervasive risk factor for poor outcome at extremely low gestations. Avoidable or effective treatment factors are identified, which may indicate the potential for improving outcome.
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Affiliation(s)
- N S Wood
- Academic Division of Child Health, Level E East Block, Queens Medical Centre, Nottingham NG7 2UH, UK
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Sampath V, Bowen J, Gibson F. Risk factors for adverse neurodevelopment in extremely low birth weight infants with normal neonatal cranial ultrasound. J Perinatol 2005; 25:210-5. [PMID: 15578032 DOI: 10.1038/sj.jp.7211228] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To determine risk factors associated with adverse developmental outcome at 5 years in extremely low birth weight infants or extremely premature infants (<28 weeks) with normal neonatal cranial ultrasounds. DESIGN/METHODS Data were collected prospectively on 152 infants with gestation <28 weeks or birth-weight <1000 g. Infants were grouped into those with normal development, mild-to-moderate impairment (IQ 70 to 84, or hearing loss 30 to 89 dB, visual acuity 6/18 to 6/60, or mild/moderate cerebral palsy (CP)) and severe impairment (IQ <70, hearing loss > or =90 dB, visual acuity <6/60, or severe CP). RESULTS Five-year outcomes were available for 144/152 children (95%). In all, 89 (62%) infants had normal development, 39 (27%) had mild-moderate impairment and 16 (11%) had severe impairment. On multivariate logistic regression analysis, factors associated with developmental impairment were serum bilirubin > or =200 micromol/l (odds ratio (OR) - 4.06, p=0.003) and retinopathy of prematurity (ROP) (OR - 1.6, p=0.03). CONCLUSIONS A serum bilirubin > or =200 micromol/l and presence of ROP are postnatal risk factors associated with an adverse developmental outcome in infants with normal cranial ultrasounds.
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Affiliation(s)
- Ai-Rhan E. Kim
- Department of Pediatrics/Division of Neonatology, Ulsan University College of Medicine, Asan Medical Center, Korea.
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Harding DR, Dhamrait S, Whitelaw A, Humphries SE, Marlow N, Montgomery HE. Does interleukin-6 genotype influence cerebral injury or developmental progress after preterm birth? Pediatrics 2004; 114:941-7. [PMID: 15466088 DOI: 10.1542/peds.2003-0494-f] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The severity of the proinflammatory response may determine outcome in the critically ill. Genetic variation in the promoter region of the gene encoding the proinflammatory cytokine interleukin-6 (IL-6; -174 CC genotype) may encode enhanced production of IL-6. Our objective was to determine whether the CC genotype is associated with worse early illness severity, neurologic injury, and lower developmental scores among surviving preterm children. METHODS Genotype was determined from dried blood spots that were taken for neonatal screening tests 7 days or more after birth; outcome was independently assessed as part of a longitudinal study of children of < or =32 weeks' gestational age. RESULTS CC genotype was associated with worse intensive care indices. Significant hemorrhagic brain injuries occurred in 5 (19%) of 27 children with CC genotype compared with 7 (6%) of 121 children with GC or GG genotype, and images consistent with white matter damage (ventriculomegaly or cystic periventricular leukomalacia) occurred in 9 (26%) of CC patients compared with 9 (7%) in GC/GG children. Disability occurred significantly more often in CC children: 8 (31%) compared with 16 (13%). A similar trend was also noted in children with cerebral palsy (15% compared with 7%, respectively). Developmental, cognitive, and motor scores at 2 years and 5.5 years were independent of genotype among children with or without disability. CONCLUSIONS In a population of surviving children who were born at < or =32 weeks' gestational age, variation of the gene that may increase IL-6 synthesis is associated with disabling brain injury but not cognitive development despite association with worse early critical care indices.
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Affiliation(s)
- David R Harding
- Department of Child Health, University of Bristol, Bristol, United Kingdom.
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Abstract
Chronic lung disease (CLD) or bronchopulmonary dysplasia is a recognized sequel of preterm birth. With improving survival of infants at lower gestational ages, the incidence is on the rise. Pathological features of CLD include alveolar maldevelopment, with or without areas of pulmonary fibrosis. Assisted ventilation, infection/inflammation, oxygen administration, and fluid overload are the major risk factors in the evolution of CLD.Interventions, including the treatment of maternal infection, administration of prenatal glucocorticoids, and postnatal surfactant replacement therapy, improve the survival of preterm infants; however, their effect on CLD is difficult to determine. Strategies that have been effective in reducing CLD are the administration of retinol (vitamin A), high frequency oscillatory ventilation, and administration of glucocorticoids. Previous concerns regarding neurological problems associated with high frequency ventilation have not been substantiated in recent studies. Current recommendations do not advise the routine use of glucocorticoids due to concerns regarding long-term neurodevelopment. Therapies that were found to be ineffective in reducing the incidence of CLD include prenatal thyrotropin, cromolyn sodium (sodium cromoglycate), alpha-1 antitrypsin, superoxide dismutase, tocopherol (vitamin E), ascorbic acid (vitamin C), allopurinol, ambroxol, inositol, inhaled bronchodilators, and fluid restriction. Strategies that may be effective in reducing lung injury and subsequent CLD include avoiding assisted ventilation, lung protective ventilatory maneuvers, permissive hypercapnia, prevention of infection, early aggressive nutrition, and the treatment of a patent ductus arteriosus. The use of inhaled glucocorticoids improves pulmonary dynamics but long-term effects are unknown. The management of infants with established CLD has not been studied adequately, and the role of various ventilatory strategies for infants with established CLD is not clear. Adequate oxygenation should be maintained to prevent hypoxic episodes. Diuretics are helpful during acute decompensation; however, their long-term impact has not been well studied. Provision of adequate nutrition, immunization (routine and against respiratory syncytial virus), follow-up, and monitoring are the key elements in the long-term management of infants with CLD. Future research priorities should be to identify strategies to prevent/treat inflammation and promote the healing processes in the injured lung. The long-term effects of lung-protective ventilation strategies need to be studied.
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Affiliation(s)
- Prakesh S Shah
- Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
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Kessenich M. Developmental outcomes of premature, low birth weight, and medically fragile infants. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s1527-3369(03)00033-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Avent M, Coile D, Mathai L. Neonatal Chronic Lung Disease. J Pharm Pract 2001. [DOI: 10.1106/j5vj-evx8-19ru-7e0b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Chronic lung disease (CLD), formerly known as bronchopulmonary dysplasia, is presently defined as the need for oxygen therapy either at 28 days of age or greater than 36 weeks postmenstrual age. Clinical signs and symptoms include tachypnea, retractions, apnea, and radiographic findings of poorly inflated lungs with reticulogranular opacities. The disease develops as a result of chronic pulmonary inflammation and continuous lung injury induced by oxygen, positive pressure ventilation, and other causes. Fifty to sixty-five percent of neonates with CLD are rehospitalized with respiratory problems, and 21% of very low birth weight neonates are diagnosed with asthma or other respiratory disorders by the age of five. These infants are at risk of adverse neurodevelopmental sequelae as they have a more complicated neonatal course. Many studies have explored various preventive therapies including α1-proteinase inhibitors, superoxide dismutase, antioxidants, and ventilatory management. Although the results from these trials are promising, further studies are needed to define which patients are most likely to benefit from preventive therapy. Two preventive treatment approaches that have shown a decrease in morbidity and an improvement in mortality are antenatal steroids and surfactant therapy. Postnatal corticosteroid therapy continues to be the mainstay of treatment for CLD, however, there are a number of detrimental side effects associated with this treatment. Due to the increased incidence in periventricular leukomalacia, early treatment of steroid therapy cannot be recommended. The optimal time to start steroid therapy appears to be after the first week of life. In addition, the lowest dose and shortest duration of treatment needs to be implemented in order to minimize potential complications. Although bronchodilators and diuretics continue to be used extensively in infants with CLD, there are surprisingly few well-controlled studies that have evaluated the clinical impact of this therapy. Further trials are needed in order to support the routine use of these therapies in CLD. Unfortunately, inhaled steroids have not shown an improvement in long-term outcomes of CLD, however, they have shown a decrease in systemic steroid usage. CLD is a complex disease with many unanswered questions. Further studies are needed to evaluate the effects of various treatment modalities with particular focus on the long-term outcomes such as oxygen and ventilator dependency as well as the incidence of CLD.
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Affiliation(s)
- Minyon Avent
- Pharmacy Department, Baylor University Medical Center, 3500 Gaston Ave., Dallas, TX 75246,
| | - Diana Coile
- College of Pharmacy, University of Texas at Austin, Austin, TX
| | - Letha Mathai
- School of Pharmacy, University of Houston, Houston, TX
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