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Dehdashtian M, Aramesh M, Malakian A, Aletayeb SMH, Rasti A. Postnatal growth failure of very low-birth-weight infants in Southwest Iran: A descriptive analytical study. Health Sci Rep 2024; 7:e1958. [PMID: 38486683 PMCID: PMC10937821 DOI: 10.1002/hsr2.1958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/01/2024] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
Background and Aims Preterm infants are more prone to poor growth and neurodevelopment. The first few weeks of life play an important role in the growth and neurodevelopment of very-low-birth-weight (VLBW) infants. The Vermont Oxford Network, evaluating the postnatal growth of preterm newborns, considers growth failure as body weight <10th percentile for postmenstrual age. This study aims to assess the frequency of postnatal growth failure in VLBW infants in Southwest Iran. Methods This descriptive analytical study was performed on VLBW infants in the neonatal intensive care unit (NICU) of Imam Khomeini Hospital (Ahvaz, Iran) from September 2019 to August 2020. Growth failure was confirmed when a newborn's weight at discharge was smaller than the 10th percentile corrected age (≤-1.28 Z-score), based on the Fenton growth chart as a standard. This study was performed on 353 infants. Intrauterine growth retardation was detected in 29% of female and 10.6% of male newborns, who were born at a gestational age of 32 and 31 weeks or higher respectively. Upon hospital discharge, postnatal growth failure was detected in all newborn girls, except for those born at 32 weeks of gestation, and all newborn boys, except for those born at a gestational age of 33-34 weeks. Conclusion Postnatal growth retardation in VLBW infants born in our NICU was much higher than that of other centers. Overcrowding, short length of hospitalization, low nurse-to-patient ratio, and untrained nurses were among the reasons for poor postnatal growth in our center.
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Affiliation(s)
- Masoud Dehdashtian
- Department of Pediatrics, Imam Khomeini HospitalAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Mohammad‐Reza Aramesh
- Department of Pediatrics, Imam Khomeini HospitalAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Arash Malakian
- Department of Pediatrics, Imam Khomeini HospitalAhvaz Jundishapur University of Medical SciencesAhvazIran
| | | | - Amene Rasti
- Department of Pediatrics, Abuzar Children's HospitalAhvaz Jundishapur University of Medical SciencesAhvazIran
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2
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Sexty RE, van der Pal S, Reijneveld SA, Wolke D, Lüchters G, Bakker L, van Buuren S, Bos AF, Bartmann P. Changes in neonatal morbidity, neonatal care practices, and length of hospital stay of surviving infants born very preterm in the Netherlands in the 1980s and in the 2000s: a comparison analysis with identical characteristics definitions. BMC Pediatr 2023; 23:554. [PMID: 37925410 PMCID: PMC10625206 DOI: 10.1186/s12887-023-04354-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 10/10/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND This study evaluates changes in the neonatal morbidity, the neonatal care practices, and the length of hospital stay of surviving very preterm (VP) infants born in the Netherlands in the 1980s and in the 2000s; a period over which historical improvements were introduced into neonatal care. We, herein, also study whether these changes in neonatal morbidity, neonatal care practices and length of hospital stay are associated with sociodemographic, prenatal, and infant characteristics. METHODS Two community-based cohorts from 1983 (POPS) and 2002-03 (LOLLIPOP) have provided the perinatal data for our study. The analysis enrolled 1,228 participants born VP (before the 32nd week of gestation) and surviving to 2 years of age without any severe congenital malformation. A rigorous harmonisation protocol ensured a precise comparison of the cohorts by using identical definitions of the perinatal characteristics. RESULTS In 2003, mothers were older when giving birth, had higher multiple birth rates, and significantly more parents had received higher education. In 2003, less VP infants had severe intraventricular haemorrhage and sepsis and relatively more received continuous positive airway pressure, mechanical ventilation and caffeine therapy than in 1983. Antenatal corticosteroids and surfactant therapy were provided only in 2003. The length of the stay in the neonatal intensive care unit and in hospital had decreased in 2003 by 22 and 11 days, respectively. Differences persisted after adjustment for sociodemographic, prenatal, and infant characteristics. CONCLUSIONS Neonatal morbidities of the surviving VP infants in this study have not increased, and exhibit improvements for various characteristics in two cohorts born 20 years apart with comparable gestational age and birth weight. Our data suggest that the improvements found are associated with more advanced therapeutic approaches and new national protocols in place, and less so with sociodemographic changes. This analysis provides a basis for further comparative analyses of the health and the development of VP children, particularly with regard to long-term outcomes.
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Affiliation(s)
- Réka E Sexty
- Department of Psychology, Health Psychology Unit, University of Graz, Graz, Austria
- University Hospital Bonn, Children's Hospital, Bonn, Germany
| | | | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK
| | - Guido Lüchters
- Centre for Development Research (ZEF), Biostatistics, Bonn, Germany
| | | | | | - Arend F Bos
- Department of Paediatrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Peter Bartmann
- University Hospital Bonn, Children's Hospital, Bonn, Germany.
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3
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Lee J, Lee CYM, Naiduvaje K, Wong Y, Bhatia A, Ereno IL, Ho SKY, Yeo CL, Rajadurai VS. Trends in neonatal mortality and morbidity in very-low-birth-weight (VLBW) infants over a decade: Singapore national cohort study. Pediatr Neonatol 2023; 64:585-595. [PMID: 36967293 DOI: 10.1016/j.pedneo.2022.12.016] [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: 06/06/2022] [Revised: 11/28/2022] [Accepted: 12/20/2022] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Very preterm infants are at risk for neurodevelopmental impairment because of postnatal morbidities. This study aims to (1) compare the outcomes of very-low-birth-weight (VLBW) infants in Singapore during two time periods over a decade; 2) compare performances among Singaporean neonatal intensive care units (NICUs); and 3) compare a Singapore national cohort with one from the Australian and New Zealand Neonatal Network (ANZNN). METHODS Singapore national data on VLBW infants born during two periods, 2007-2008 (SG2007, n = 286) and 2015-2017 (SG2017, n = 905) were extracted from patient medical records. The care practices and clinical outcomes among three Singapore NICUs were compared using SG2017 data. Third, using data from the ANZNN2017 annual report, infants with gestational age (GA) ≤29 weeks in SG2017 were compared with their Oceania counterparts. RESULTS SG2017 had 9.9% higher usage of antenatal steroids (p < 0.001), 8% better survival for infants ≤26 weeks (p = 0.174), and used 12.7% lesser nonsteroidal anti-inflammatory drugs for patent ductus arteriosus closure (p < 0.001) than those of SG2007 cohort. Rate of late-onset sepsis (LOS) was almost halved (7.4% vs. 14.0%, p < 0.001), and exclusive human milk feeding after discharge increased threefold (p < 0.001). SG2017, in contrast, had a higher rate of chronic lung disease (CLD) (20.0% vs. 15.1%, p = 0.098). Within SG2017, the rates of LOS, CLD, and human milk feeding varied significantly between the three NICUs. When compared with ANZNN2017, SG2017 had significantly lower rates of LOS for infants ≤25 weeks (p = 0.001), less necrotizing enterocolitis for infants ≤27 weeks (p = 0.002), and less CLD across all GA groups. CONCLUSION Postnatal morbidities and survival rates for VLBW infants in Singapore have improved over a decade. Outcomes for VLBW infants varied among three Singapore NICUs, which provide a rationale for collaboration to improve clinical quality. The outcomes of Singaporean VLBW infants were comparable to those of their ANZNN counterparts.
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Affiliation(s)
- Jiun Lee
- Department of Neonatology, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore.
| | - Cheryl Yen May Lee
- Department of Paediatrics, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore
| | - Krishnamoorthy Naiduvaje
- Department of Neonatology, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore
| | - Yoko Wong
- Singapore Clinical Research Institute, Singapore
| | - Ashwani Bhatia
- Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | | | - Selina Kah Yin Ho
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - Cheo Lian Yeo
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
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4
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Edwards JD. A Focused Review of Long-Stay Patients and the Ethical Imperative to Provide Inpatient Continuity. Semin Pediatr Neurol 2023; 45:101037. [PMID: 37003634 DOI: 10.1016/j.spen.2023.101037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 04/03/2023]
Abstract
Long-stay patients are an impactful, vulnerable, growing group of inpatients in today's (and tomorrow's) tertiary hospitals. They can outlast dozens of clinicians that necessarily rotate on and off clinical service. Yet, care from such rotating clinicians can result in fragmented care due to a lack of continuity that insufficiently meets the needs of these patients and their families. Using long-stay PICU patients as an example, this focused review discusses the impact of prolonged admissions and how our fragmented care can compound this impact. It also argues that it is an ethical imperative to provide a level of continuity of care beyond what is considered standard of care and offers a number of strategies that can provide such continuity.
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Affiliation(s)
- Jeffrey D Edwards
- Section of Critical Care, Department of Pediatrics, Columbia University Vagelos College of Physician and Surgeons, New York, NY..
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Mikolajcikova S, Lasabova Z, Holubekova V, Skerenova M, Zibolenova J, Matasova K, Zibolen M, Calkovska A. The Common Haplotype GATGACA in Surfactant-Protein B Gene Is Protective for Respiratory Distress Syndrome in Preterm Neonates. Front Pediatr 2022; 10:851042. [PMID: 35692980 PMCID: PMC9174893 DOI: 10.3389/fped.2022.851042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Respiratory distress syndrome (RDS), a disorder of primary surfactant deficiency resulting in pulmonary insufficiency, remains a significant problem for preterm neonates. Associations between genetic variants of surfactant proteins and RDS have been reported, but haplotypes of the surfactant protein B gene (SFTPB) have not been studied. The aim of the study was to prove the hypothesis that certain haplotypes of SFTPB may be protective or risk factors for RDS. Methods The study was performed with 149 preterm infants, born <34 weeks of gestation, with 86 infants with mild RDS or without RDS (control group) and 63 infants with severe RDS (patient group). RDS was considered severe if multiple doses of exogenous surfactant and/or mechanical ventilation within the first 72 h of life were needed. The venous blood sample was used for the analysis of gene polymorphisms associated with RDS, genotyping, and haplotype estimation. Multivariate logistic regression analysis and the odds ratio were calculated to detect the contribution of the studied variables to the development of RDS. Results A new association of the common single nucleotide polymorphism (SNP) rs2304566 with RDS in premature infants was detected. Analysis of rs2304566 polymorphisms using a logistic regression model showed that there are two significant predictors inversely related to the occurrence of RDS (Apgar score of 5 min, CT and TT genotype in rs2304566 polymorphism). Gestational age, birth weight, and sex have border significance. Moreover, in the patient group, the frequency of the GATGACA haplotype in the SFTPB gene was lower (p = 0.037), and the GATGGCA haplotype was higher (p = 0.059) in comparison with the control group. Conclusion The common haplotype GATGACA of the SFTPB gene can be protective against RDS in preterm infants. The trend of a higher frequency of GATGGCA in the SFTPB gene in infants with severe RDS suggests that this haplotype may be a risk factor for RDS susceptibility.
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Affiliation(s)
- Silvia Mikolajcikova
- Clinic of Neonatology, Jessenius Faculty of Medicine, Comenius University and University Hospital, Martin, Slovakia
| | - Zora Lasabova
- Department of Molecular Biology and Genomics, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Veronika Holubekova
- Biomedical Centre Martin, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Maria Skerenova
- Biomedical Centre Martin, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Jana Zibolenova
- Department of Public Health, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Katarina Matasova
- Clinic of Neonatology, Jessenius Faculty of Medicine, Comenius University and University Hospital, Martin, Slovakia
| | - Mirko Zibolen
- Clinic of Neonatology, Jessenius Faculty of Medicine, Comenius University and University Hospital, Martin, Slovakia
| | - Andrea Calkovska
- Department of Physiology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
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6
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Ingemyr K, Elfvin A, Hentz E, Saggers RT, Ballot DE. Factors influencing survival and short-term outcomes of very low birth weight infants in a tertiary hospital in Johannesburg. Front Pediatr 2022; 10:930338. [PMID: 36186656 PMCID: PMC9523153 DOI: 10.3389/fped.2022.930338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The neonatal mortality rate in South Africa is lower than the global average, but still approximately five times higher than some European and Scandinavian countries. Prematurity, and its complications, is the main cause (35%) of neonatal deaths. OBJECTIVE To review the maternal, delivery period and infant characteristics in relation to mortality in very low birth weight (VLBW) infants at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). METHODS This was a retrospective descriptive study of VLBW infants admitted to CMJAH between 1 January 2017 and 31 December 2018. All infants with a birth weight between 500 to ≤ 1,500 grams were included. The characteristics and survival of these infants were described using univariate analysis. RESULTS Overall survival was 66.5%. Provision of antenatal steroids, antenatal care, Cesarean section, female sex, resuscitation at birth, and 5-min Apgar score more than five was related with better survival to discharge. Among respiratory diagnoses, 82.8% were diagnosed with RDS, 70.8% received surfactant therapy and 90.7% received non-invasive respiratory support after resuscitation. At discharge, 59.5% of the mothers were breastfeeding and 30.8% spent time in kangaroo mother care. CONCLUSION The two-thirds survival rate of VLBW infants is similar to those in other developing countries but still remains lower than developed countries. This may be improved with better antenatal care attendance, coverage of antenatal steroids, temperature control after birth, improving infection prevention and control practices, breastfeeding rates and kangaroo mother care. The survival rate was lowest amongst extremely low birth weight (ELBW) infants.
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Affiliation(s)
- Kristin Ingemyr
- Department of Paediatrics, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Anders Elfvin
- Department of Paediatrics, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.,Region Västra Götaland, Department of Paediatrics, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elisabet Hentz
- Department of Paediatrics, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.,Region Västra Götaland, Department of Paediatrics, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Robin T Saggers
- Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.,School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daynia E Ballot
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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7
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Amjad S, Adesunkanmi M, Twynstra J, Seabrook JA, Ospina MB. Social Determinants of Health and Adverse Outcomes in Adolescent Pregnancies. Semin Reprod Med 2021; 40:116-123. [PMID: 34500474 DOI: 10.1055/s-0041-1735847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The association between adolescent childbearing and adverse maternal and birth outcomes has been well documented. Adverse adolescent pregnancy outcomes are associated with substantial risk of long-term morbidities for the young mother and their newborns. Multiple levels of social disadvantage have been related to adverse pregnancy outcomes among adolescent mothers. Patterns of cumulative social adversity define the most marginalized group of adolescents at the highest risk of experiencing adverse maternal and birth outcomes. Using a social determinants of health (SDOH) framework, we present an overview of the current scientific evidence on the influence of these conditions on adolescent pregnancy outcomes. Multiple SDOH such as residence in remote areas, low educational attainment, low socioeconomic status, and lack of family and community support have been linked with increased risk of adverse pregnancy outcomes among adolescents. Based on the PROGRESS-Plus equity framework, this review highlights some SDOH aspects that perinatal health researchers, clinicians, and policy makers should consider in the context of adolescent pregnancies. There is a need to acknowledge the intersectional nature of multiple SDOH when formulating clinical and societal interventions to address the needs of the most marginalized adolescent in this critical period of life.
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Affiliation(s)
- S Amjad
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - M Adesunkanmi
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - J Twynstra
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada
| | - J A Seabrook
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada.,Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Children's Health Research Institute and Lawson Health Research Institute, London, Ontario, Canada
| | - M B Ospina
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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8
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Seaton SE, Draper ES, Adams M, Kusuda S, Håkansson S, Helenius K, Reichman B, Lehtonen L, Bassler D, Lee SK, Vento M, Darlow BA, Rusconi F, Beltempo M, Isayama T, Lui K, Norman M, Yang J, Shah PS, Modi N. Variations in Neonatal Length of Stay of Babies Born Extremely Preterm: An International Comparison Between iNeo Networks. J Pediatr 2021; 233:26-32.e6. [PMID: 33600820 DOI: 10.1016/j.jpeds.2021.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/13/2021] [Accepted: 02/09/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To compare length of stay (LOS) in neonatal care for babies born extremely preterm admitted to networks participating in the International Network for Evaluating Outcomes of Neonates (iNeo). STUDY DESIGN Data were extracted for babies admitted from 2014 to 2016 and born at 24 to 28 weeks of gestational age (n = 28 204). Median LOS was calculated for each network for babies who survived and those who died while in neonatal care. A linear regression model was used to investigate differences in LOS between networks after adjusting for gestational age, birth weight z score, sex, and multiplicity. A sensitivity analysis was conducted for babies who were discharged home directly. RESULTS Observed median LOS for babies who survived was longest in Japan (107 days); this result persisted after adjustment (20.7 days more than reference, 95% CI 19.3-22.1). Finland had the shortest adjusted LOS (-4.8 days less than reference, 95% CI -7.3 to -2.3). For each week's increase in gestational age at birth, LOS decreased by 12.1 days (95% CI -12.3 to -11.9). Multiplicity and male sex predicted mean increases in LOS of 2.6 (95% CI 2.0-3.2) and 2.1 (95% CI 1.6-2.6) days, respectively. CONCLUSIONS We identified between-network differences in LOS of up to 3 weeks for babies born extremely preterm. Some of these may be partly explained by differences in mortality, but unexplained variations also may be related to differences in clinical care practices and healthcare systems between countries.
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Affiliation(s)
- Sarah E Seaton
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom.
| | - Elizabeth S Draper
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Mark Adams
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Satoshi Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Stellan Håkansson
- Department of Clinical Sciences/Pediatrics, Umeå University Hospital, Umeå, Sweden
| | - Kjell Helenius
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Ramat Gan, Israel
| | - Liisa Lehtonen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Shoo K Lee
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Maximo Vento
- Division of Neonatology and Health Research Institute La Fe, Valencia, Spain
| | - Brian A Darlow
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Franca Rusconi
- Unit of Epidemiology, Anna Meyer Children's Hospital, Florence, Italy
| | | | - Tetsuya Isayama
- Division of Neonatology, Center of Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kei Lui
- School of Women's and Children's Health, University of New South Wales, Australia
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Junmin Yang
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Neena Modi
- UK Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
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9
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van Beek PE, Groenendaal F, Broeders L, Dijk PH, Dijkman KP, van den Dungen FAM, van Heijst AFJ, van Hillegersberg JL, Kornelisse RF, Onland W, Schuerman FABA, van Westering-Kroon E, Witlox RSGM, Andriessen P. Survival and causes of death in extremely preterm infants in the Netherlands. Arch Dis Child Fetal Neonatal Ed 2021; 106:251-257. [PMID: 33158971 PMCID: PMC8070636 DOI: 10.1136/archdischild-2020-318978] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 08/27/2020] [Accepted: 09/21/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE In the Netherlands, the threshold for offering active treatment for spontaneous birth was lowered from 25+0 to 24+0 weeks' gestation in 2010. This study aimed to evaluate the impact of guideline implementation on survival and causes and timing of death in the years following implementation. DESIGN National cohort study, using data from the Netherlands Perinatal Registry. PATIENTS The study population included all 3312 stillborn and live born infants with a gestational age (GA) between 240/7 and 266/7 weeks born between January 2011 and December 2017. Infants with the same GA born between January 2007 and December 2009 (N=1400) were used as the reference group. MAIN OUTCOME MEASURES Survival to discharge, as well as cause and timing of death. RESULTS After guideline implementation, there was a significant increase in neonatal intensive care unit (NICU) admission rate for live born infants born at 24 weeks' GA (27%-69%, p<0.001), resulting in increased survival to discharge in 24-week live born infants (13%-34%, p<0.001). Top three causes of in-hospital mortality were necrotising enterocolitis (28%), respiratory distress syndrome (19%) and intraventricular haemorrhage (17%). A significant decrease in cause of death either complicated or caused by respiratory insufficiency was seen over time (34% in 2011-2014 to 23% in 2015-2017, p=0.006). CONCLUSIONS Implementation of the 2010 guideline resulted as expected in increased NICU admissions rate and postnatal survival of infants born at 24 weeks' GA. In the years after implementation, a shift in cause of death was seen from respiratory insufficiency towards necrotising enterocolitis and sepsis.
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Affiliation(s)
- Pauline E van Beek
- Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lisa Broeders
- The Netherlands Perinatal Registry, Utrecht, The Netherlands
| | - Peter H Dijk
- Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Koen P Dijkman
- Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands
| | | | - Arno F J van Heijst
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - René F Kornelisse
- Department of Pediatrics, Devision of Neonatology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Wes Onland
- Department of Neonatology, Emma Childrens Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | | | - Ruben S G M Witlox
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Andriessen
- Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, The Netherlands
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10
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European Resuscitation Council Guidelines 2021: Newborn resuscitation and support of transition of infants at birth. Resuscitation 2021; 161:291-326. [PMID: 33773829 DOI: 10.1016/j.resuscitation.2021.02.014] [Citation(s) in RCA: 233] [Impact Index Per Article: 77.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The European Resuscitation Council has produced these newborn life support guidelines, which are based on the International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support. The guidelines cover the management of the term and preterm infant. The topics covered include an algorithm to aid a logical approach to resuscitation of the newborn, factors before delivery, training and education, thermal control, management of the umbilical cord after birth, initial assessment and categorisation of the newborn infant, airway and breathing and circulation support, communication with parents, considerations when withholding and discontinuing support.
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11
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Marinelli KC, Lyden ER, Peeples ES. Clinical risk factors for the development of late-onset circulatory collapse in premature infants. Pediatr Res 2021; 89:968-973. [PMID: 32492694 DOI: 10.1038/s41390-020-0990-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Very low birth weight (VLBW) infants may be at risk for late-onset circulatory collapse (LCC) where otherwise stable infants develop hypotension resistant to vasoactive agents. The risk factors for LCC development are poorly defined, and it has been theorized that it may be in part due to withdrawal from exogenous prenatal steroids. The goal of this study was to define the clinical characteristics of LCC and investigate its association with antenatal steroid administration. METHODS This is a retrospective cohort study of infants born ≤1500 g. LCC was retrospectively diagnosed in infants requiring glucocorticoids for circulatory instability at >1 week of life. Demographic and clinical characteristics were compared between groups using Mann-Whitney test. RESULTS Three hundred and ten infants were included; 19 (6.1%) developed LCC. Infants with LCC were born at a median 4.6 weeks' lower gestation, 509 g lower birth weight than those without LCC. There was no difference in antenatal steroid delivery between the groups. CONCLUSIONS LCC occurs in a distinct subset of VLBW infants, suggesting the need for monitoring in this high-risk population. Antenatal steroids did not significantly increase the risk of LCC development in this study. IMPACT Late-onset circulatory collapse (LCC) is a life-threatening clinical entity occurring in around 6% in VLBW infants and is likely underdiagnosed in the United States. Targeting specific demographic characteristics such as birth weight (<1000 g) and gestational age at birth (<26 weeks) may allow for early identification of high-risk infants, allowing close monitoring and prompt treatment of LCC. No significant association was found between antenatal steroid administration and LCC development, suggesting that the theoretical risks of antenatal steroids on the fetal HPA axis does not outweigh the benefits of antenatal steroids in fetal lung maturity. To date, no studies characterizing LCC have originated outside of Asia. Therefore, providing a description of LCC in a U.S.-based cohort will provide insight into both its prevalence and presentation to inform clinicians about this potentially devastating disorder and foster early diagnosis and treatment. This study validates LCC characteristics and prevalence previously outlined by Asian studies in a single-center U.S.-based cohort while also identifying potential risk factors for LCC development. This manuscript will provide education for U.S. physicians about the risk factors and clinical presentation of LCC to facilitate early diagnosis and treatment, potentially decreasing neonatal mortality. With prompt recognition and treatment of LCC, infants may have decreased exposure to vasoactive medications that have significant systemic effects.
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Affiliation(s)
| | - Elizabeth R Lyden
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Eric S Peeples
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA.
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Michaelis IA, Krägeloh-Mann I, Manyisane N, Mazinu MC, Jordaan ER. Prospective cohort study of mortality in very low birthweight infants in a single centre in the Eastern Cape province, South Africa. BMJ Paediatr Open 2021; 5:e000918. [PMID: 33665373 PMCID: PMC7893654 DOI: 10.1136/bmjpo-2020-000918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background Neonatal mortality is a major contributor worldwide to the number of deaths in children under 5 years of age. The primary objective of this study was to assess the overall mortality rate of babies with a birth weight equal or below 1500 g in a neonatal unit at a tertiary hospital in the Eastern Cape Province, South Africa. Furthermore, different maternal-related and infant-related factors for higher mortality were analysed. Methods This is a prospective cohort study which included infants admitted to the neonatal wards of the hospital within their first 24 hours of life and with a birth weight equal to or below 1500 g. Mothers who consented answered a questionnaire to identify factors for mortality. Results 173 very low birth weight (VLBW) infants were recruited in the neonatal department between November 2017 and December 2018, of whom 55 died (overall mortality rate 32.0%). Twenty-three of the 44 infants (53,5%) with a birth weight below 1000 g died during the admission. One hundred and sixty-one mothers completed the questionnaire and 45 of their babies died.Main factors associated with mortality were lower gestational age and lower birth weight. Need for ventilator support and sepsis were associated with higher mortality, as were maternal factors such as HIV infection and age below 20 years. Conclusion This prospective study looked at survival of VLBW babies in an underprivileged part of the Eastern Cape of South Africa. Compared with other public urban hospitals in the country, the survival rate remains unacceptably low. Further research is required to find the associated causes and appropriate ways to address these.
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Affiliation(s)
- Isabel A Michaelis
- Paediatrics, Walter Sisulu University, Mthatha, Eastern Cape, South Africa
| | - Ingeborg Krägeloh-Mann
- Children's Hospital, Neuropaediatrics, Developmental Neurology, Social Paediatrics, Eberhard Karls University Tübingen Faculty of Medicine, Tübingen, Baden-Württemberg, Germany
| | - Ncomeka Manyisane
- Paediatrics, Walter Sisulu University, Mthatha, Eastern Cape, South Africa
| | - Mikateko C Mazinu
- Biostatistics unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
| | - Esme R Jordaan
- Biostatistics unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
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Abstract
The European Resuscitation Council has produced these newborn life support guidelines, which are based on the International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support. The guidelines cover the management of the term and preterm infant. The topics covered include an algorithm to aid a logical approach to resuscitation of the newborn, factors before delivery, training and education, thermal control, management of the umbilical cord after birth, initial assessment and categorisation of the newborn infant, airway and breathing and circulation support, communication with parents, considerations when withholding and discontinuing support.
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14
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Al-Matary A, AlJohani E, Qaraqei M. Estimating the neonatal length of stay for preterm babies in a saudi tertiary hospital. J Clin Neonatol 2020. [DOI: 10.4103/jcn.jcn_115_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Kardum D, Filipović-Grčić B, Müller A, Dessardo S. SURVIVAL UNTIL DISCHARGE OF VERY-LOW-BIRTH-WEIGHT INFANTS IN TWO CROATIAN PERINATAL CARE REGIONS: A RETROSPECTIVE COHORT STUDY OF TIME AND CAUSE OF DEATH. Acta Clin Croat 2019; 58:446-454. [PMID: 31969756 PMCID: PMC6971806 DOI: 10.20471/acc.2019.58.03.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We investigated mortality, causes, timing and risk factors for death until hospital discharge in very-low-birth-weight (VLBW) infants born in two Croatian perinatal care regions. This retrospective study included 252 live born VLBW infants. The mortality rate until hospital discharge was 30.5% (77/252). VLBW infants who died had by 4 weeks lower gestational age (GA) than surviving infants (median GA, 25 vs. 29 weeks), lower birth weight (BW) (mean BW, 756.4 vs. 1126.4 g), lower 5-minute Apgar score (median 5 vs. 8) and were more often resuscitated at birth (41.6 vs. 19.4%; p<0.001 all). Infants who survived were more often small-for-gestational age (SGA) (28.0 vs. 15.6%; p=0.04) and more often received continuous-positive-airway-pressure (CPAP) in delivery room (13.1 vs. 2.6%; p=0.01). Multivariate logistic regression revealed that parameters influencing death until hospital discharge were 5-minute Apgar score (OR 0.780, 95% CI 0.648-0.939) and higher Clinical Risk Index for Babies (CRIB) score (OR 1.677, 95% CI 1.456-1.931). ROC analysis showed that CRIB score (AUC 0.927, sensitivity 92.2, specificity 81.1; p<0.001) was the strongest predictor of death until hospital discharge. In infants who died within 12 hours, death was most commonly attributed to immaturity and in those surviving >12 hours to necrotizing enterocolitis.
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Affiliation(s)
- Darjan Kardum
- 1Neonatal Intensive Care Unit, Department of Pediatrics, Osijek University Hospital Centre, Osijek, Croatia; 2School of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia; 3Neonatal Intensive Care Unit, Department of Pediatrics, Zagreb University Hospital Centre, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5Department of Gynecology and Obstetrics, Osijek University Hospital Centre, Osijek, Croatia; 6Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, Rijeka University Hospital Centre, Rijeka, Croatia; 7School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Boris Filipović-Grčić
- 1Neonatal Intensive Care Unit, Department of Pediatrics, Osijek University Hospital Centre, Osijek, Croatia; 2School of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia; 3Neonatal Intensive Care Unit, Department of Pediatrics, Zagreb University Hospital Centre, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5Department of Gynecology and Obstetrics, Osijek University Hospital Centre, Osijek, Croatia; 6Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, Rijeka University Hospital Centre, Rijeka, Croatia; 7School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Andrijana Müller
- 1Neonatal Intensive Care Unit, Department of Pediatrics, Osijek University Hospital Centre, Osijek, Croatia; 2School of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia; 3Neonatal Intensive Care Unit, Department of Pediatrics, Zagreb University Hospital Centre, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5Department of Gynecology and Obstetrics, Osijek University Hospital Centre, Osijek, Croatia; 6Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, Rijeka University Hospital Centre, Rijeka, Croatia; 7School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Sandro Dessardo
- 1Neonatal Intensive Care Unit, Department of Pediatrics, Osijek University Hospital Centre, Osijek, Croatia; 2School of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia; 3Neonatal Intensive Care Unit, Department of Pediatrics, Zagreb University Hospital Centre, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5Department of Gynecology and Obstetrics, Osijek University Hospital Centre, Osijek, Croatia; 6Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, Rijeka University Hospital Centre, Rijeka, Croatia; 7School of Medicine, University of Rijeka, Rijeka, Croatia
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16
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Ojha S, Mitchell E, Montgomery A, Dorling J. Full Milk Feeds from Day 1. Neonatology 2019; 116:67. [PMID: 31048589 DOI: 10.1159/000499676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Shalini Ojha
- Division of Graduate Entry Medicine and Medical Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom,
| | - Eleanor Mitchell
- Nottingham Clinical Trial Unit, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Alan Montgomery
- Nottingham Clinical Trial Unit, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Jon Dorling
- Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract
OBJECTIVES To compare duration and changes over time in length of hospital stay for very preterm and extremely preterm infants in 10 European regions. DESIGN Two area-based cohort studies from the same regions in 2003 and 2011/2012. SETTING Ten regions from nine European countries. PATIENTS Infants born between 22 + 0 and 31 + 6 weeks of gestational age and surviving to discharge (Models of Organising Access to Intensive Care for Very Preterm Births cohort in 2003, n = 4,011 and Effective Perinatal Intensive Care in Europe cohort in 2011/2012, n = 4,336). INTERVENTIONS Observational study, no intervention. MEASUREMENTS AND MAIN RESULTS Maternal and infant characteristics were abstracted from medical records using a common protocol and length of stay until discharge was adjusted for case-mix using negative binomial regression. Mean length of stay was 63.6 days in 2003 and varied from 52.4 to 76.5 days across regions. In 2011/2012, mean length of stay was 63.1 days, with a narrower regional range (54.0-70.1). Low gestational age, small for gestational age, low 5-minute Apgar score, surfactant administration, any surgery, and severe neonatal morbidities increased length of stay. Infant characteristics explained some of the differences between regions and over time, but large variations remained after adjustment. In 2011/2012, mean adjusted length of stay ranged from less than 54 days in the Northern region of the United Kingdom and Wielkopolska, Poland to over 67 days in the Ile-de-France region of France and the Eastern region of the Netherlands. No systematic decrease in very preterm length of stay was observed over time after adjustment for patient case-mix. CONCLUSIONS A better understanding of the discharge criteria and care practices that contribute to the wide differences in very preterm length of stay across European regions could inform policies to optimize discharge decisions in terms of infant outcomes and health system costs.
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18
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Helenius K, Sjörs G, Shah PS, Modi N, Reichman B, Morisaki N, Kusuda S, Lui K, Darlow BA, Bassler D, Håkansson S, Adams M, Vento M, Rusconi F, Isayama T, Lee SK, Lehtonen L. Survival in Very Preterm Infants: An International Comparison of 10 National Neonatal Networks. Pediatrics 2017; 140:peds.2017-1264. [PMID: 29162660 DOI: 10.1542/peds.2017-1264] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To compare survival rates and age at death among very preterm infants in 10 national and regional neonatal networks. METHODS A cohort study of very preterm infants, born between 24 and 29 weeks' gestation and weighing <1500 g, admitted to participating neonatal units between 2007 and 2013 in the International Network for Evaluating Outcomes of Neonates. Survival was compared by using standardized ratios (SRs) comparing survival in each network to the survival estimate of the whole population. RESULTS Network populations differed with respect to rates of cesarean birth, exposure to antenatal steroids and birth in nontertiary hospitals. Network SRs for survival were highest in Japan (SR: 1.10; 99% confidence interval: 1.08-1.13) and lowest in Spain (SR: 0.88; 99% confidence interval: 0.85-0.90). The overall survival differed from 78% to 93% among networks, the difference being highest at 24 weeks' gestation (range 35%-84%). Survival rates increased and differences between networks diminished with increasing gestational age (GA) (range 92%-98% at 29 weeks' gestation); yet, relative differences in survival followed a similar pattern at all GAs. The median age at death varied from 4 days to 13 days across networks. CONCLUSIONS The network ranking of survival rates for very preterm infants remained largely unchanged as GA increased; however, survival rates showed marked variations at lower GAs. The median age at death also varied among networks. These findings warrant further assessment of the representativeness of the study populations, organization of perinatal services, national guidelines, philosophy of care at extreme GAs, and resources used for decision-making.
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Affiliation(s)
- Kjell Helenius
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Kiinamyllynkatu, Turku, Finland; .,Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Gunnar Sjörs
- National Quality Registry for Neonatal Care, Department of Pediatrics/Neonatal Services, University Hospital of Umeå, Umeå, Sweden
| | - Prakesh S Shah
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Maternal-Infant Care Research Centre, and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Neena Modi
- United Kingdom Neonatal Collaborative, Neonatal Data Analysis Unit, and Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Satoshi Kusuda
- Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Kei Lui
- Royal Hospital for Women, and National Perinatal Epidemiology and Statistics Unit, University of New South Wales, Randwick, Australia
| | - Brian A Darlow
- Department of Pediatrics, University of Otago, Christchurch, New Zealand
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stellan Håkansson
- National Quality Registry for Neonatal Care, Department of Pediatrics/Neonatal Services, University Hospital of Umeå, Umeå, Sweden
| | - Mark Adams
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Maximo Vento
- Health Research Institute La Fe, Avenida Fernando Abril Martorell, Valencia, Spain; and
| | - Franca Rusconi
- TIN Toscane Online, Unit of Epidemiology, Meyer Children's University Hospital, Florence, Italy and Regional Health Agency of Tuscany, Florence, Italy
| | - Tetsuya Isayama
- Maternal-Infant Care Research Centre, and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Shoo K Lee
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Maternal-Infant Care Research Centre, and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Kiinamyllynkatu, Turku, Finland.,Department of Clinical Medicine, University of Turku, Turku, Finland
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19
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Mueller M, Kramer BW. Stem cells and Bronchopulmonary Dysplasia - The five questions: Which cells, when, in which dose, to which patients via which route? Paediatr Respir Rev 2017; 24:54-59. [PMID: 28162941 DOI: 10.1016/j.prrv.2016.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 12/06/2016] [Indexed: 12/14/2022]
Abstract
Preterm birth is the leading cause of death in newborns and children. Despite advances in perinatology, immature infants continue to face serious risks such chronic respiratory impairment from bronchopulmonary dysplasia (BPD). Current treatment options are insufficient and novel approaches are desperately needed. In recent years stem cells have emerged as potential candidates to treat BPD with mesenchymal stem/stromal cells (MSCs) being particularly promising. MSCs originate from several stem cell niches including bone marrow, skin, or adipose, umbilical cord, and placental tissues. Although the first MSCs clinical trials in BPD are ongoing, multiple questions remain open. In this review, we discuss the question of the optimal cell source (live cells or cell products), route and timing of the transplantation. Furthermore, we discuss MSCs possible capacities including migration, homing, pro-angiogenesis, anti-inflammatory, and tissue-regenerative potential as well.
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Affiliation(s)
- Martin Mueller
- Department of Obstetrics and Gynecology, University Hospital Bern, Bern, Switzerland; Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA; Department of Clinical Research, University of Bern, Bern, Switzerland.
| | - Boris W Kramer
- Department of Pediatrics, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; School of Oncology and Developmental Biology (GROW), Maastricht, The Netherlands.
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20
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Klitkou ST, Iversen T, Stensvold HJ, Rønnestad A. Use of hospital-based health care services among children aged 1 through 9 years who were born very preterm - a population-based study. BMC Health Serv Res 2017; 17:571. [PMID: 28818072 PMCID: PMC5561635 DOI: 10.1186/s12913-017-2498-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Very preterm (VPT) children, with a birth weight below 1500 g or delivered before 32 weeks of gestational age, are at increased risk of poorer long-term health outcomes and higher rates of hospitalization in childhood. However, considerable variation exists in the need for in-hospital care within this population. We assessed the utilization and distribution of hospital-based care from ages 1 through 9 years for a nationwide population. METHODS This was a population-based cohort of VPT children born in the period 2001-2009. We evaluated their utilization of hospital care in 2008-2010, when aged 1-9 years old. Outcomes were the incidence of hospital admissions and outpatient visits. We used Poisson regression models with multiple imputation of missing data. RESULTS Children born VPT had more hospital admissions compared with the general population of children aged 1-9 years. The rates of hospital admissions and outpatient visits were strongly related to clinical characteristics of the child at birth and age at admission/outpatient visit but to only a variable and minor degree to characteristics pertaining to maternal health, the sociodemographic factors, and geographical proximity to hospital services. CONCLUSIONS Prior to this study, hospital utilization during the period 5-9 years old has been poorly documented. We found that excess utilization of hospital resources on average declines with increasing age. We also noted substantial differences in the use of hospital care across age groups and clinical factors for VPT children. The added information from the health status of mothers, social background, and geographic measures of access was limited.
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Affiliation(s)
- Søren T Klitkou
- Department of Health Management and Health Economics, University of Oslo, P.b. 1089 Blindern, NO 0317, Oslo, Norway.
| | - Tor Iversen
- Department of Health Management and Health Economics, University of Oslo, P.b. 1089 Blindern, NO 0317, Oslo, Norway
| | - Hans J Stensvold
- Clinic for Pediatric and Adolescent Medicine, Neonatal Intensive Care Unit, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Arild Rønnestad
- Clinic for Pediatric and Adolescent Medicine, Neonatal Intensive Care Unit, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
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21
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Numerato D, Fattore G, Tediosi F, Zanini R, Peltola M, Banks H, Mihalicza P, Lehtonen L, Sveréus S, Heijink R, Klitkou ST, Fletcher E, van der Heijden AA, Lundberg F, Over E, Häkkinen U, Seppälä TT. Correction: Mortality and Length of Stay of Very Low Birth Weight and Very Preterm Infants: A EuroHOPE Study. PLoS One 2017; 12:e0177040. [PMID: 28459851 PMCID: PMC5411028 DOI: 10.1371/journal.pone.0177040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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22
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Barkhuizen M, van den Hove DLA, Vles JSH, Steinbusch HWM, Kramer BW, Gavilanes AWD. 25 years of research on global asphyxia in the immature rat brain. Neurosci Biobehav Rev 2017; 75:166-182. [PMID: 28161509 DOI: 10.1016/j.neubiorev.2017.01.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 01/27/2017] [Accepted: 01/29/2017] [Indexed: 10/20/2022]
Abstract
Hypoxic-ischemic encephalopathy remains a common cause of brain damage in neonates. Preterm infants have additional complications, as prematurity by itself increases the risk of encephalopathy. Currently, therapy for this subset of asphyxiated infants is limited to supportive care. There is an urgent need for therapies in preterm infants - and for representative animal models for preclinical drug development. In 1991, a novel rodent model of global asphyxia in the preterm infant was developed in Sweden. This method was based on the induction of asphyxia during the birth processes itself by submerging pups, still in the uterine horns, in a water bath followed by C-section. This insult occurs at a time-point when the rodent brain maturity resembles the brain of a 22-32 week old human fetus. This model has developed over the past 25 years as an established model of perinatal global asphyxia in the early preterm brain. Here we summarize the knowledge gained on the short- and long-term neuropathological and behavioral effects of asphyxia on the immature central nervous system.
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Affiliation(s)
- M Barkhuizen
- Department of Pediatrics, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; DST/NWU Preclinical Drug Development Platform, North-West University, Potchefstroom, South Africa
| | - D L A van den Hove
- Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - J S H Vles
- Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Child Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - H W M Steinbusch
- Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
| | - B W Kramer
- Department of Pediatrics, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
| | - A W D Gavilanes
- Department of Pediatrics, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Institute of Biomedicine, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Ecuador.
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23
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Mueller M, Oppliger B, Joerger-Messerli M, Reinhart U, Barnea E, Paidas M, Kramer BW, Surbek DV, Schoeberlein A. Wharton's Jelly Mesenchymal Stem Cells Protect the Immature Brain in Rats and Modulate Cell Fate. Stem Cells Dev 2016; 26:239-248. [PMID: 27842457 DOI: 10.1089/scd.2016.0108] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The development of a mammalian brain is a complex and long-lasting process. Not surprisingly, preterm birth is the leading cause of death in newborns and children. Advances in perinatal care reduced mortality, but morbidity still represents a major burden. New therapeutic approaches are thus desperately needed. Given that mesenchymal stem/stromal cells (MSCs) emerged as a promising candidate for cell therapy, we transplanted MSCs derived from the Wharton's Jelly (WJ-MSCs) to reduce the burden of immature brain injury in a murine animal model. WJ-MSCs transplantation resulted in protective activity characterized by reduced myelin loss and astroglial activation. WJ-MSCs improved locomotor behavior as well. To address the underlying mechanisms, we tested the key regulators of responses to DNA-damaging agents, such as cyclic AMP-dependent protein kinase/calcium-dependent protein kinase (PKA/PKC), cyclin-dependent kinase (CDK), ataxia-telangiectasia-mutated/ATM- and Rad3-related (ATM/ATR) substrates, protein kinase B (Akt), and 14-3-3 binding protein partners. We characterized WJ-MSCs using a specific profiler polymerase chain reaction array. We provide evidence that WJ-MSCs target pivotal regulators of the cell fate such as CDK/14-3-3/Akt signaling. We identified leukemia inhibitory factor as a potential candidate of WJ-MSCs' induced modifications as well. We hypothesize that WJ-MSCs may exert adaptive responses depending on the type of injury they are facing, making them prominent candidates for cell therapy in perinatal injuries.
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Affiliation(s)
- Martin Mueller
- 1 Department of Clinical Research, University of Bern , Bern, Switzerland .,2 Department of Obstetrics and Gynecology, University of Bern , Bern, Switzerland .,3 Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine , New Haven, Connecticut
| | - Byron Oppliger
- 1 Department of Clinical Research, University of Bern , Bern, Switzerland .,2 Department of Obstetrics and Gynecology, University of Bern , Bern, Switzerland
| | - Marianne Joerger-Messerli
- 1 Department of Clinical Research, University of Bern , Bern, Switzerland .,2 Department of Obstetrics and Gynecology, University of Bern , Bern, Switzerland
| | - Ursula Reinhart
- 1 Department of Clinical Research, University of Bern , Bern, Switzerland .,2 Department of Obstetrics and Gynecology, University of Bern , Bern, Switzerland
| | - Eytan Barnea
- 4 Society for the Investigation of Early Pregnancy and BioIncept LLC , Cherry Hill, New Jersey
| | - Michael Paidas
- 3 Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine , New Haven, Connecticut
| | - Boris W Kramer
- 5 Department of Pediatrics, Maastricht University Medical Center (MUMC) , Maastricht, the Netherlands .,6 Division Neuroscience, Department of Neuropsychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University , Maastricht, the Netherlands
| | - Daniel V Surbek
- 1 Department of Clinical Research, University of Bern , Bern, Switzerland .,2 Department of Obstetrics and Gynecology, University of Bern , Bern, Switzerland
| | - Andreina Schoeberlein
- 1 Department of Clinical Research, University of Bern , Bern, Switzerland .,2 Department of Obstetrics and Gynecology, University of Bern , Bern, Switzerland
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24
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Mueller M, Wolfs TGA, Schoeberlein A, Gavilanes AWD, Surbek D, Kramer BW. Mesenchymal stem/stromal cells-a key mediator for regeneration after perinatal morbidity? Mol Cell Pediatr 2016; 3:6. [PMID: 26869264 PMCID: PMC4751100 DOI: 10.1186/s40348-016-0034-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 01/19/2016] [Indexed: 02/07/2023] Open
Abstract
Perinatal complications in both term- and preterm-born infants are a leading cause of neonatal morbidities and mortality. Infants face different challenges in the neonatal intensive care unit with long-term morbidities such as perinatal brain injury and bronchopulmonary dysplasia being particularly devastating. While advances in perinatal medicine have improved our understanding of the pathogenesis, effective therapies to prevent and/or reduce the severity of these disorders are still lacking. The potential of mesenchymal stem/stromal cell (MSC) therapy has emerged during the last two decades, and an increasing effort is conducted to address brain- and lung-related morbidities in neonates at risk. Various studies support the notion that MSCs have protective effects. MSCs are an easy source and may be readily available after birth in a clinical setting. MSCs' mechanisms of action are diverse, including migration and homing, release of growth factors and immunomodulation, and the potential to replace injured cells. Here, we review the pathophysiology of perinatally acquired brain and lung injuries and focus on MSCs as potential candidates for therapeutic strategies summarizing preclinical and clinical evidence.
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Affiliation(s)
- Martin Mueller
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
- Department of Obstetrics and Gynecology, University Hospital Bern and Department of Clinical Research, University of Bern, Bern, Switzerland.
| | - Tim G A Wolfs
- Department of Pediatrics, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands.
- School of Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands.
| | - Andreina Schoeberlein
- Department of Obstetrics and Gynecology, University Hospital Bern and Department of Clinical Research, University of Bern, Bern, Switzerland.
| | - Antonio W D Gavilanes
- Department of Pediatrics, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands.
- Institute of Biomedicine, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador.
- Department of Neuropsychology, Division Neuroscience, School of Mental Health and neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands.
| | - Daniel Surbek
- Department of Obstetrics and Gynecology, University Hospital Bern and Department of Clinical Research, University of Bern, Bern, Switzerland.
| | - Boris W Kramer
- Department of Pediatrics, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands.
- School of Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands.
- Department of Neuropsychology, Division Neuroscience, School of Mental Health and neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands.
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25
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Shah PS, Lui K, Sjörs G, Mirea L, Reichman B, Adams M, Modi N, Darlow BA, Kusuda S, San Feliciano L, Yang J, Håkansson S, Mori R, Bassler D, Figueras-Aloy J, Lee SK. Neonatal Outcomes of Very Low Birth Weight and Very Preterm Neonates: An International Comparison. J Pediatr 2016; 177:144-152.e6. [PMID: 27233521 DOI: 10.1016/j.jpeds.2016.04.083] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 04/05/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare rates of a composite outcome of mortality or major morbidity in very-preterm/very low birth weight infants between 8 members of the International Network for Evaluating Outcomes. STUDY DESIGN We included 58 004 infants born weighing <1500 g at 24(0)-31(6) weeks' gestation from databases in Australia/New Zealand, Canada, Israel, Japan, Spain, Sweden, Switzerland, and the United Kingdom. We compared a composite outcome (mortality or any of grade ≥3 peri-intraventricular hemorrhage, periventricular echodensity/echolucency, bronchopulmonary dysplasia, or treated retinopathy of prematurity) between each country and all others by using standardized ratios and pairwise using logistic regression analyses. RESULTS Despite differences in population coverage, included neonates were similar at baseline. Composite outcome rates varied from 26% to 42%. The overall mortality rate before discharge was 10% (range: 5% [Japan]-17% [Spain]). The standardized ratio (99% CIs) estimates for the composite outcome were significantly greater for Spain 1.09 (1.04-1.14) and the United Kingdom 1.16 (1.11-1.21), lower for Australia/New Zealand 0.93 (0.89-0.97), Japan 0.89 (0.86-0.93), Sweden 0.81 (0.73-0.90), and Switzerland 0.77 (0.69-0.87), and nonsignificant for Canada 1.04 (0.99-1.09) and Israel 1.00 (0.93-1.07). The adjusted odds of the composite outcome varied significantly in pairwise comparisons. CONCLUSIONS We identified marked variations in neonatal outcomes between countries. Further collaboration and exploration is needed to reduce variations in population coverage, data collection, and case definitions. The goal would be to identify care practices and health care organizational factors, which has the potential to improve neonatal outcomes.
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Affiliation(s)
- Prakesh S Shah
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
| | - Kei Lui
- Australian and New Zealand Neonatal Network, Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, University of New South Wales, Randwick, Australia
| | - Gunnar Sjörs
- Swedish Neonatal Quality Register, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Lucia Mirea
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Brian Reichman
- Israel Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer, Israel
| | - Mark Adams
- Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Neena Modi
- UK Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital campus, London, United Kingdom
| | - Brian A Darlow
- Australia and New Zealand Neonatal Network, Department of Pediatrics, University of Otago, Christchurch, New Zealand
| | - Satoshi Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
| | - Laura San Feliciano
- Spanish Neonatal Network, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Junmin Yang
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Stellan Håkansson
- Swedish Neonatal Quality Register, Department of Pediatrics/Neonatal Services, Umeå University Hospital, Umeå, Sweden
| | - Rintaro Mori
- Neonatal Research Network Japan, Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Dirk Bassler
- Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | | | - Shoo K Lee
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
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Häkkinen U, Iversen T, Peltola M, Rehnberg C, Seppälä TT. Towards Explaining International Differences in Health Care Performance: Results of the EuroHOPE Project. HEALTH ECONOMICS 2015; 24 Suppl 2:1-4. [PMID: 26633864 DOI: 10.1002/hec.3282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 09/28/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Unto Häkkinen
- Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland
| | - Tor Iversen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Mikko Peltola
- Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland
| | - Clas Rehnberg
- Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Timo T Seppälä
- Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland
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27
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Heijink R, Engelfriet P, Rehnberg C, Kittelsen SAC, Häkkinen U. A Window on Geographic Variation in Health Care: Insights from EuroHOPE. HEALTH ECONOMICS 2015; 24 Suppl 2:164-177. [PMID: 26633874 DOI: 10.1002/hec.3287] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 10/08/2015] [Accepted: 10/08/2015] [Indexed: 06/05/2023]
Abstract
The aim of EuroHOPE was to provide new evidence on the performance of healthcare systems, using a disease-based approach, linkable patient-level data and internationally standardized methods. This paper summarizes its main results. In the seven EuroHOPE countries, the Acute Myocardial Infarction (AMI), stroke and hip fracture patient populations were similar with regard to age, sex and comorbidity. However, non-negligible geographic variation in mortality and resource use was found to exist. Survival rates varied to similar extents between countries and regions for AMI, stroke, hip fracture and very low birth weight. Geographic variation in length of stay differed according to type of disease. Regression analyses showed that only a small part of geographic variation could be explained by demand and supply side factors. Furthermore, the impact of these factors varied between countries. The findings show that there is room for improvement in performance at all levels of analysis and call for more in-depth disease-based research. In using international patient-level data and a standardized methodology, the EuroHOPE approach provides a promising stepping-stone for future investigations in this field. Still, more detailed patient and provider information, including outside of hospital care, and better data sharing arrangements are needed to reach a more comprehensive understanding of geographic variations in health care.
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Affiliation(s)
- Richard Heijink
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Peter Engelfriet
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Clas Rehnberg
- Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | | | - Unto Häkkinen
- Centre for Health and Social Economics (CHESS), National Institute for Health and Welfare, Helsinki, Finland
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