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Suenaga H, Nakanishi H, Uchiyama A, Kusuda S. Small for Gestational Age Affects Outcomes on Singletons and Inborn Births in Extremely Preterm Infants: A Japanese Cohort Study. Am J Perinatol 2024; 41:e780-e787. [PMID: 36041470 DOI: 10.1055/a-1933-4627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This study aimed to compare the short- and long-term outcomes of extremely preterm small for gestational age (SGA) infants and appropriate for gestational age (AGA) infants in Japan. STUDY DESIGN We retrospectively assessed 434 SGA and 1,716 AGA infants born at 22 to 27 weeks of gestational age (GA) and examined their outcomes on singletons and inborn births between 2003 and 2012. Infants were followed-up for 3 years, and the clinical characteristics and outcomes were compared. Fisher's exact and Student's t-tests were used for independent sample comparison. Logistic regression was used to identify associated factors. RESULTS The prevalence of intraventricular hemorrhage ≥ grade 3 was significantly lower (adjusted odds ratio [aOR]: 0.28; 95% confidence interval [CI]: 0.11 - 0.72), and the prevalence of bronchopulmonary dysplasia at 36 weeks of GA and the need for home oxygen therapy were significantly higher (aOR: 2.20; 95% CI: 1.66 - 2.91 and aOR: 2.46; 95% CI: 1.75-3.47, respectively) in SGA infants than in AGA infants. SGA infants born at 24 to 25 weeks of GA had a significantly higher prevalence of developmental quotient (DQ) < 70 (aOR: 1.73; 95% CI: 1.08 - 2.77). Those born at 26 to 27 weeks of GA showed a significantly higher prevalence of cerebral palsy (CP) and visual impairment (aOR: 2.31; 95% CI: 1.22 - 4.40 and aOR: 2.61; 95% CI: 1.21 - 5.61, respectively). CONCLUSION In SGA infants, birth at 24 to 25 weeks of GA is an independent risk factor for DQ < 70, and birth at 26 to 27 weeks of GA is an independent risk factor for CP and visual impairment. However, we did not consider nutritional and developmental factors, and a longer follow-up would help assess neurodevelopmental outcomes. KEY POINTS · SGA is a risk factor for poor outcomes.. · In SGA infants, birth at 25 to 26 weeks is a risk factor for low a DQ.. · In SGA infants, birth at 26 to 27 weeks is a risk factor for CP..
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Affiliation(s)
- Hideyo Suenaga
- Department of pediatrics, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Hidehiko Nakanishi
- Department of Advanced Medicine, Research and Development Center for New Medical Frontiers, Kanagawa, Japan
| | - Atsushi Uchiyama
- Department of Pediatrics, Tokai University School of Medicine, Kanagawa, Japan
| | - Satoshi Kusuda
- Department of Pediatrics, Kyorin University, Tokyo, Japan
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Bhagat AK, Mehendale AM, Muneshwar KN. Factors Associated With Low Birth Weight Among the Tribal Population in India: A Narrative Review. Cureus 2024; 16:e53478. [PMID: 38440021 PMCID: PMC10911641 DOI: 10.7759/cureus.53478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 02/02/2024] [Indexed: 03/06/2024] Open
Abstract
Low birth weight (LBW) is defined by the WHO as a birth weighing less than 2500 g (5.5 lb). The highest burden of any nation is LBW infants. In countries where the frequency of neonate babies is high, short gestation is a major cause. LBW babies have an 11-13 times greater risk of delayed developmental milestones and other medical diagnoses. Greater than the global incidence, LBW prevalence is a severe public health problem in India. A comprehensive literature search was conducted using internet sources like PubMed, Web of Science, Cochrane Library, and Google Scholar. The words "birth weight," "abnormal birth weight," "LBWs," "neonates," "premature birth," "risks factors," "causes," "factors," "prevalence," and "frequency" were searched. In this review, we examine the causes of LBW, implementation of pre-birth prevention strategies, and post-birth multifaceted health promotion interventions. The mother's knowledge, dietary requirements, and prenatal services need to be addressed to decrease the prevalence of LBWs among tribal districts of India.
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Affiliation(s)
- Arpana K Bhagat
- School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ashok M Mehendale
- Preventive Medicine, Department of Community Medicine, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Komal N Muneshwar
- Preventive Medicine, Department of Community Medicine, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Zhang L, Fang X, Li Z, Han X, Du H, Qu P, Xu F, Wu L, Li Y. Establishment of a prediction model for histological chorioamnionitis and its association with outcomes of premature infants. Front Pediatr 2023; 11:1194563. [PMID: 37654686 PMCID: PMC10466889 DOI: 10.3389/fped.2023.1194563] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
Aim This study aims to construct a prediction model for histological chorioamnionitis (HCA) and analyze the associations between the predicted risk of HCA and adverse outcomes in preterm infants. Methods In total, 673 subjects were included in this cohort study and divided into HCA group (n = 195) and non-HCA group (n = 478). A stepwise method was used to screen the predictors for HCA, binary logistic regression was used to construct the prediction model, and the associations between the predicted risk of HCA and adverse outcomes were analyzed. Results HCA occurred in 195 patients, accounting for 29.0%. The sensitivity of the prediction model was 0.821 [95% confidence interval (CI): 0.767-0.874)], the specificity was 0.684 (95% CI: 0.642-0.726), the positive predictive value was 0.514 (0.459-0.570), the negative predictive value was 0.903 (95% CI: 0.873-0.934), the area under the curve was 0.821 (95% CI: 0.786-0.855), and the accuracy was 0.724 (95% CI: 0.690-0.757). The predicted risk of HCA was associated with a higher risk of bronchopulmonary dysplasia (BPD) [odds ratio (OR) = 3.48, 95% CI: 1.10-10.95)], sepsis (OR = 6.66, 95% CI: 2.17-20.43), and neonatal infections (OR = 9.85, 95% CI: 3.59-26.98), but not necrotizing enterocolitis (OR = 0.67, 95% CI: 0.24-1.88), retinopathy of prematurity (OR = 1.59, 95% CI: 0.37-6.85), and brain damage (OR = 1.77, 95% CI: 0.82-3.83). After adjusting for confounders including gestational week at birth and birth weight, the risk of neonatal infections (OR = 5.03, 95% CI: 2.69-9.41) was increased in preterm infants' exposure to HCA. Conclusion The model showed good predictive performance for identifying pregnant women with a higher risk of HCA. In addition, HCA was associated with the risk of BPD, sepsis, and infections in neonates.
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Affiliation(s)
- Li Zhang
- Department of Neonatology, Northwest Women’s and Children’s Hospital, Xi’an, China
| | - Xin Fang
- Graduate School of Xi’an Medical University, Xi’an, China
| | - Zhankui Li
- Department of Neonatology, Northwest Women’s and Children’s Hospital, Xi’an, China
| | - Xiang Han
- Department of Obstetric, Northwest Women’s and Children’s Hospital, Xi’an, China
| | - Hongyan Du
- Department of Pathology, Northwest Women’s and Children’s Hospital, Xi’an, China
| | - Pengfei Qu
- Translational Medicine Center, Northwest Women’s and Children’s Hospital, Xi’an, China
| | - Feifei Xu
- Graduate School of Xi’an Medical University, Xi’an, China
| | - Lizhi Wu
- Department of Neonatology, Northwest Women’s and Children’s Hospital, Xi’an, China
| | - Yajun Li
- Department of Neonatology, Northwest Women’s and Children’s Hospital, Xi’an, China
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Maytasari GM, Haksari EL, Prawirohartono EP. Predictors of Bronchopulmonary Dysplasia in Infants With Birth Weight Less Than 1500 g. Glob Pediatr Health 2023; 10:2333794X231152199. [PMID: 36756633 PMCID: PMC9900159 DOI: 10.1177/2333794x231152199] [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] [Received: 11/22/2022] [Accepted: 12/28/2022] [Indexed: 02/05/2023] Open
Abstract
Bronchopulmonary dysplasia (BPD) is a complication of preterm and low birth weight infants. The incidence of BPD has not decreased over the past 20 years. Complications of BPD include rehospitalization, chronic lung disease, cardiovascular disease, and impaired growth and development which will affect the patient's quality of life. There are unfortunately limited data available regarding BPD in Indonesia. This study is expected to be a reference in taking preventive measures to reduce mortality and morbidity in preterm and low birth infants. This study aims to determine predictors of BPD in infants with birth weight less than 1500 g. We conducted a retrospective cohort study that included 116 infants with birth weight <1500 g. Twenty-two (19%) infants had BPD with the highest proportion (63.6%) in the 28 to 31 weeks of gestational age. Multivariate analysis showed mechanical ventilation in more than first 2 days of life (P = .008; HR = 7.7), hematocrit <39% (P = .001; HR = 12), and hemodynamically significant patent ductus arteriosus (hsPDA; P = .041; HR = 3.5) were significant predictors of BPD in infants with birth weight <1500 g.
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Affiliation(s)
- Galuh Martin Maytasari
- Universitas Gadjah Mada/Dr. Sardjito
General Hospital, Yogyakarta, Indonesia,Galuh Martin Maytasari, Department of Child
Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah
Mada, Jalan Farmako, Senolowo, Sekip Utara, Yogyakarta 55281, Indonesia.
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Harris C, Greenough A. The prevention and management strategies for neonatal chronic lung disease. Expert Rev Respir Med 2023; 17:143-154. [PMID: 36813477 DOI: 10.1080/17476348.2023.2183842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Survival from even very premature birth is improving, but long-term respiratory morbidity following neonatal chronic lung disease (bronchopulmonary dysplasia (BPD)) has not reduced. Affected infants may require supplementary oxygen at home, because they have more hospital admissions particularly due to viral infections and frequent, troublesome respiratory symptoms requiring treatment. Furthermore, adolescents and adults who had BPD have poorer lung function and exercise capacity. AREAS COVERED Antenatal and postnatal preventative strategies and management of infants with BPD. A literature review was undertaken using PubMed and Web of Science. EXPERT OPINION There are effective preventative strategies which include caffeine, postnatal corticosteroids, vitamin A, and volume guarantee ventilation. Side-effects, however, have appropriately caused clinicians to reduce use of systemically administered corticosteroids to infants only at risk of severe BPD. Promising preventative strategies which need further research are surfactant with budesonide, less invasive surfactant administration (LISA), neurally adjusted ventilatory assist (NAVA) and stem cells. The management of infants with established BPD is under-researched and should include identifying the optimum form of respiratory support on the neonatal unit and at home and which infants will most benefit in the long term from pulmonary vasodilators, diuretics, and bronchodilators.
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Affiliation(s)
- Christopher Harris
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, UK
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, UK
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[Sex differences in clinical outcomes of extremely preterm infants/extremely low birth weight infants: a propensity score matching study]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:514-520. [PMID: 35644191 PMCID: PMC9154374 DOI: 10.7499/j.issn.1008-8830.2201049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To study the effect of sex on the clinical outcome of extremely preterm infants (EPIs)/extremely low birth weight infants (ELBWIs) by propensity score matching. METHODS A retrospective analysis was performed for the medical data of 731 EPIs or ELBWIs who were admitted from January 1, 2011 to December 31, 2020. These infants were divided into two groups: male and female. A propensity score matching analysis was performed at a ratio of 1:1. The matching variables included gestational age, birth weight, percentage of withdrawal from active treatment, percentage of small-for-gestational-age infant, percentage of use of pulmonary surfactant, percentage of 1-minute Apgar score ≤3, percentage of mechanical ventilation, duration of mechanical ventilation, percentage of antenatal use of inadequate glucocorticoids, and percentage of hypertensive disorders in pregnancy. The two groups were compared in the incidence rate of main complications during hospitalization and the rate of survival at discharge. RESULTS Before matching, compared with the female group, the male group had significantly higher incidence rates of neonatal respiratory distress syndrome, bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, and patent ductus arteriosus (P<0.05), while after matching, the male group only had a significantly higher incidence rate of BPD than the female group (P<0.05). There was no significant difference in the rate of survival at discharge between the two groups before and after matching (P>0.05). CONCLUSIONS Male EPIs/ELBWIs have a higher risk of BPD than female EPIs/ELBWIs, but male and female EPIs/ELBWIs tend to have similar outcomes.
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Haksari EL, Hakimi M, Ismail D. Respiratory distress in small for gestational age infants based on local newborn curve prior to hospital discharge. Front Pediatr 2022; 10:986695. [PMID: 36245714 PMCID: PMC9561821 DOI: 10.3389/fped.2022.986695] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/15/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Respiratory distress in newborns, which may lead to risks of morbidity and death, is one of the reasons for a referral to the more advanced health facilities. Respiratory distress analysis in small for gestational age (SGA) infants remains controversial. SGA infants are a big problem for and burden the low-medium income countries. Frequentness of SGA infants varies, depending on birth weight curve used. OBJECTIVE To identify the risks, complications, death induced by respiratory distress in SGA infants prior to hospital discharge. METHODS A retrospective cohort study was conducted on live- born infants at Sardjito Hospital. Singleton and gestational age 26-42 weeks were the inclusion criteria. The exclusion criteria included major congenital anomaly, chromosomal abnormalities, out-born infants admitted >24 h, discharge against medical advice, and incomplete data. The samples were categorized into appropriate gestational age (AGA) and SGA by a local newborn curve. The samples were also classified as full-term (FT)-AGA, preterm (PT)-AGA, FT-SGA, and PT-SGA. Odds ratio (OR) was based on entire respiratory distress. Complications of respiratory distress analyzed were length of hospital stay, administration of oxygen, Continuous Positive Airway Pressure (CPAP), and ventilator. Reverse Kaplan-Meier and Cumulative Mortality Incidence (CMI) were used to analyze respiratory distress-induced mortality. Stata 13 was used to analyze the data. RESULTS There were 12,490 infants eligible for the study, consisting of 9,396 FT-AGA infants, 2,003 PT-AGA infants, 771 FT-SGA infants, and 320 PT-SGA infants. Nine hundred and thirty-two infants developed respiratory distress. Multiple logistic regression analysis revealed highest risk of respiratory distress in PT-SGA infants with OR 5.84 (4.28-7.99). The highest respiratory distress complications were found in PT- SGA with significant difference on length of hospital stay and IRR 2.62 (2.09-3.27). In addition, the highest use of mechanical ventilator was found in PT-SGA with significant difference. CPAP use was the highest in PT-AGA infants. There was no significant difference in oxygen administration among the groups. Respiratory distress-induced mortality analysis found the highest CMI in PT-SGA infants. CONCLUSION PT-SGA had the highest risk of respiratory distress with complications of length of hospital stay, and ventilator use. Mortality analysis discovered the highest CMI in PT-SGA infants. We should therefore be alert when dealing with PT-SGA infants.
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Affiliation(s)
- Ekawaty Lutfia Haksari
- Department of Child Health, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Sardjito General Hospital, Yogyakarta, Indonesia
| | - Mohammad Hakimi
- Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Djauhar Ismail
- Department of Child Health, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Sardjito General Hospital, Yogyakarta, Indonesia
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Mangiza M, Ehret DEY, Edwards EM, Rhoda N, Tooke L. Morbidity and mortality in small for gestational age very preterm infants in a middle-income country. Front Pediatr 2022; 10:915796. [PMID: 36016879 PMCID: PMC9396138 DOI: 10.3389/fped.2022.915796] [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: 04/08/2022] [Accepted: 07/13/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To evaluate the impact of small for gestational age (SGA) on outcomes of very preterm infants at Groote Schuur Hospital (GSH), Cape Town, South Africa. STUDY DESIGN Data were obtained from the Vermont Oxford Network (VON) GSH database from 2012 to 2018. The study is a secondary analysis of prospectively collected observational data. Fenton growth charts were used to define SGA as birth weight < 10th centile for gestational age. RESULTS Mortality [28.9% vs. 18.5%, adjusted risk ratio (aRR) 2.1, 95% confidence interval (CI) 1.6-2.7], bronchopulmonary dysplasia (BPD; 14% vs. 4.5%, aRR 3.7, 95% CI 2.3-6.1), and late-onset sepsis (LOS; 16.7% vs. 9.6%, aRR 2.3, 95% CI 1.6-3.3) were higher in the SGA than in the non-SGA group. CONCLUSION Small for gestational age infants have a higher risk of mortality and morbidity among very preterm infants at GSH. This may be useful for counseling and perinatal management.
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Affiliation(s)
- Marcia Mangiza
- Groote Schuur Hospital, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Danielle E Y Ehret
- Vermont Oxford Network, Burlington, VT, United States.,Department of Paediatrics, Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Erika M Edwards
- Vermont Oxford Network, Burlington, VT, United States.,Department of Paediatrics, Larner College of Medicine, University of Vermont, Burlington, VT, United States.,Department of Mathematics and Statistics, University of Vermont, Burlington, VT, United States
| | - Natasha Rhoda
- Groote Schuur Hospital, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Lloyd Tooke
- Groote Schuur Hospital, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
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Wang H, Li QF, Xu XF, Hu XL. Study on improving collection feeding safety and quality of colostrum for very (extremely) low birth weight infants. Front Pediatr 2022; 10:1069719. [PMID: 36866084 PMCID: PMC9972579 DOI: 10.3389/fped.2022.1069719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/21/2022] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE This study aims to explore the difficulties related to fresh colostrum feeding for very (extremely) low birth weight infants (VLBWI/ELBWI) and optimize the colostrum administration process. METHODS The VLBWI/ELBWI who were admitted in the neonatal intensive care unit from January to December 2021, were enrolled as the experimental group, and an optimized colostrum feeding process was adopted. The VLBWI/ELBWI admitted from January to December 2020 were enrolled as the control group, and a conventional feeding process was adopted. The general situation of colostrum supply, number of adverse feeding events, maternal breastfeeding rate at the critical time points. RESULTS There were no significant differences between the baseline charatcteristics of the 2 groups. In the experimental group, compared with the control group, the time to first colostrum collection was significantly shorter (64.8% vs. 57.8% p < 0.05), and the rates of colostrum feeding (44.1% vs. 70.5% p < 0.001), and of maternal breastfeeding at 2 weeks after birth (56.1% vs. 46.7%, p < 0.05) and on the day of discharge (46.2% vs. 37.8%, p < 0.05) were significantly higher. Before and after process optimization, the average total time required for the time for nurses to receive the colostrum in the NICU reduced from 7.5 min/time to 2 min/time, and no feeding-related adverse events occurred. CONCLUSION Fresh colostrum feeding process optimization for VLBWI/ELBWI, improves the colostrum feeding rate, shortens the time to first colostrum collection, saves the working time of nurses, and improves the maternal breastfeeding rate at key time points.
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Affiliation(s)
- Hua Wang
- Department of NICU, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiu-Fang Li
- Department of Nursing, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xin-Fen Xu
- Department of Nursing, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao-Li Hu
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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House M, Nathan A, Bhuiyan MAN, Ahlfeld SK. Morbidity and respiratory outcomes in infants requiring tracheostomy for severe bronchopulmonary dysplasia. Pediatr Pulmonol 2021; 56:2589-2596. [PMID: 34002957 DOI: 10.1002/ppul.25455] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The decision for tracheostomy for bronchopulmonary dysplasia (BPD) is highly variable and often dictated by local practice. We aimed to characterize morbidity, mortality, and respiratory outcomes in preterm infants undergoing tracheostomy for severe BPD. STUDY DESIGN We retrospectively reviewed a single-center 4-year cohort of all infants born <33 weeks gestational age (GA) that required tracheostomy due to severe BPD. Indications for tracheostomy apart from BPD were excluded. Demographic information, comorbidities, respiratory management, age at tracheostomy, post-discharge respiratory outcomes, and survival were examined up to at least 5 years of age. RESULTS At a mean corrected GA of 43.3 weeks, 49 preterm infants with severe BPD required tracheostomy. Forty-six infants (94%) had long-term follow-up. Compared to survivors, the 12 (26.1%) infants that died were significantly more likely to be small for gestational age (SGA) or require treatment for pulmonary hypertension. GA, birth weight, sex, antenatal corticosteroid exposure, need for patent ductus arteriosus ligation, and magnitude of respiratory support at tracheostomy placement were not associated with mortality. At the latest follow-up, 97% were liberated from mechanical ventilation and 79% decannulated. Morbidities of the upper airway were common, and 13/27 (47%) decannulated infants had required airway reconstruction. CONCLUSION Preterm infants undergoing tracheostomy experienced significant mortality, particularly those who were SGA or had pulmonary hypertension. However, by 5 years of age, most infants liberalized from mechanical ventilation and decannulated. Magnitude of respiratory support at time of tracheostomy was not associated with mortality and should not deter intervention. Nearly half of patients required airway reconstruction before decannulation.
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Affiliation(s)
- Melissa House
- Division of Neonatology and Pulmonary Biology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Amy Nathan
- Division of Neonatology and Pulmonary Biology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Shawn K Ahlfeld
- Division of Neonatology and Pulmonary Biology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Harris C, Lunt A, Bisquera A, Peacock J, Greenough A. Intrauterine growth retardation and lung function of very prematurely born young people. Pediatr Pulmonol 2021; 56:2284-2291. [PMID: 33666356 DOI: 10.1002/ppul.25359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/27/2021] [Accepted: 03/01/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To assess if intrauterine growth retardation (IUGR) was associated with reduced lung function at 16-19 years. WORKING HYPOTHESIS Very prematurely born young people who had IUGR would have reduced lung function postpuberty. STUDY DESIGN Prospective follow-up study. PATIENT-SUBJECT SELECTION One hundred and fifty-nine 16-19 year olds born before 29 weeks of gestation; 37 had IUGR. METHODOLOGY Lung function tests were performed: spirometry was used to assess forced expiratory volume in one second (FEV1), forced expiratory flow at 75%, 50% and 25% of expired vital capacity (FEF75, FEF50 and FEF25), peak expiratory flow (PEF) and forced vital capacity (FVC). Functional residual capacity (FRCpleth) total lung capacity (TLCpleth) and residual volume (RVpleth) were measured. Alveolar function was assessed by diffusion capacity within the lungs of carbon monoxide (DLCO). Impulse oscillometry was used to assess respiratory resistance and lung clearance index to assess ventilation homogeneity. Exercise capacity was assessed using a shuttle sprint test. RESULTS After adjustment for BMI, the mean FEV-1/FVC, FEF75, FEF25-75, FRCpleth and RVpleth were poorer in those who had had IUGR, with differences between 0.56 and 0.75 z-scores. After further adjustment for BPD and postnatal corticosteroid use, only the difference in RVpleth z-scores remained statistically significant, adjusted difference (95% CI): 0.66 (0.18,1.13). Exercise capacity was lower in those with IUGR and this was more pronounced in males (p=0.04). CONCLUSIONS At 16-19 years of age, those who had IUGR had poorer lung function and exercise capacity compared with those with adequate intrauterine growth.
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Affiliation(s)
- Christopher Harris
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Alan Lunt
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Alessandra Bisquera
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Janet Peacock
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA.,NIHR Biomedical Research Center based at Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,NIHR Biomedical Research Center based at Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK.,Asthma UK Center in Allergic Mechanisms of Asthma, King's College London, London, UK
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Primary anastomosis as a valid alternative for extremely low birth weight infants with spontaneous intestinal perforation. Eur J Pediatr 2021; 180:1529-1535. [PMID: 33438068 PMCID: PMC8032622 DOI: 10.1007/s00431-021-03926-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/13/2020] [Accepted: 01/01/2021] [Indexed: 11/17/2022]
Abstract
The aim was to assess the results of primary anastomosis (PA) compared to enterostomy (ES) in infants with spontaneous intestinal perforation (SIP) and a weight below 1000 g. Between 2014 and 2016, enterostomy was routinely carried out on extremely low birth weight (ELBW) patients with SIP. From 2016 until 2019, all patients underwent anastomosis without stoma formation. We compared outcome and complications in both groups. Forty-two patients with a median gestational age of 24.3 weeks and a birth weight of 640 g with SIP were included. Thirty patients underwent PA; ES was performed in 12 patients. Overall in-hospital mortality was 11.9% (PA: 13.3%, ES: 8.3%). Reoperations due to complications became necessary in 10/30 patients with PA and 4/12 patients with ES. Length of stay was 110.5 days in the PA group and 124 days in the ES group. Median weight at discharge was higher in the PA group (PA: 2258 g, ES: 1880 g, p = .036).Conclusion: Primary anastomosis is a feasible treatment option for SIP in infants < 1000 g and may have a positive impact on weight gain and length of hospitalization. However, further studies on selection criteria for PA are necessary. What is Known: • Enterostomy (ES) and primary anastomosis (PA) are feasible treatment options in preterm infants with spontaneous intestinal perforation (SIP). • Stomal complications or failure to thrive due to poor food utilization can pose significant problems. What is New: • Primary anastomosis in case of SIP is equal to enterostomy in terms of mortality and revision rate; however, length of stay and weight gain can be presumably positively influenced. • Primary anastomosis is a valid treatment option even for patients weighing less than 1000 g.
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Greenough A, Decobert F, Field D, Hallman M, Hummler HD, Jonsson B, Sánchez Luna M, Van Overmeire B, Carnielli VP, Potenziano JL, Mercier JC. Inhaled nitric oxide (iNO) for preventing prematurity-related bronchopulmonary dysplasia (BPD): 7-year follow-up of the European Union Nitric Oxide (EUNO) trial. J Perinat Med 2020; 49:104-110. [PMID: 32892178 DOI: 10.1515/jpm-2020-0164] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/08/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Most studies of inhaled nitric oxide (iNO) for prevention of bronchopulmonary dysplasia (BPD) in premature infants have focused on short-term mortality and morbidity. Our aim was to determine the long-term effects of iNO. METHODS A 7-year follow-up was undertaken of infants entered into a multicenter, double-blind, randomized, placebo-controlled trial of iNO for prevention of BPD in premature infants born between 24 and 28 weeks plus six days of gestation. At 7 years, survival and hospital admissions since the 2-year follow-up, home oxygen therapy in the past year, therapies used in the previous month and growth assessments were determined. Questionnaires were used to compare general health, well-being, and quality of life. RESULTS A total of 305 children were assessed. No deaths were reported. Rates of hospitalization for respiratory problems (6.6 vs. 10.5%, iNO and placebo group, respectively) and use of respiratory medications (6.6 vs. 9.2%) were similar. Two patients who received iNO and one who received placebo had received home oxygen therapy. There were no significant differences in any questionnaire-documented health outcomes. CONCLUSIONS iNO for prevention of BPD in very premature infants with respiratory distress did not result in long-term benefits or adverse long-term sequelae. In the light of current evidence, routine use of iNO cannot be recommended for prevention of BPD in preterm infants.
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Affiliation(s)
| | | | - David Field
- University of Leicester Centre for Medicine, Leicester, UK
| | - Mikko Hallman
- University of Oulu and Oulu University Hospital, Oulu, Finland
| | | | - Baldvin Jonsson
- Karolinska University Hospital and Institute, Stockholm, Sweden
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Poryo M, Maas S, Gortner L, Geipel M, Zemlin M, Löffler G, Meyer S. Effects of small for gestational age status on mortality and major morbidities in ≤750 g neonates. Early Hum Dev 2020; 144:105040. [PMID: 32325371 DOI: 10.1016/j.earlhumdev.2020.105040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/23/2020] [Accepted: 03/31/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Controversy exists regarding the impact of small for gestational age (SGA = birth weight < 10th percentile) status on mortality and major morbidities. AIM To assess the effects of SGA on mortality and major morbidities in ≤750 gram (g) neonates. STUDY DESIGN Retrospective (01/2005-12/2017), single center study at a tertiary NICU. SUBJECTS SGA neonates ≤ 750 g. OUTCOME Effect of SGA status on mortality and major morbidities. RESULTS 183 infants were enrolled. 103 (56.3%) were non-SGA (mean gestational age 25 + 1 weeks ± 9.9 days, mean birth weight 662.6 ± 75.2 g), and 80 (43.7%) SGA (mean gestational age 26 + 6 weeks ± 14.0 days, mean birth weight 543.9 ± 114.7 g). Mortality was 24.1% (non-SGA: 30/103 (29.1%), SGA: 14/80 (17.5%); p = 0.08). Univariable logistic regression analysis revealed a significant protective effect of SGA status on pneumothoraces (OR 0.28, 95%-CI [0.11-0.69]), IVH (≥3) (OR 0.38; 95%-CI [0.15-0.67]), and seizures (OR 0.09, 95%-CI [0.01-0.76]), but NEC (≥2a) occurred more frequently in SGA neonates (p = 0.024). Multiple logistic regression analysis found SGA status to negatively influence ROP (≥3) (OR 2.87, 95%-CI [1.14-7.23]) and need for home monitoring (OR 2.38, 95%-CI [1.05-5.41]). Other major morbidities (IVH, PVL, RDS, BPD, NEC, FIP, sepsis, hearing impairment) and mortality rates were not significantly affected, but distinct organ-specific patterns were seen. CONCLUSION SGA had negative effects on the rate of severe ROP and the need for home monitoring, but other major morbidities as well as mortality rates were not significantly affected. In the future, it will be important to delineate underlying pathophysiological mechanisms that contribute to this pattern.
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Affiliation(s)
- Martin Poryo
- Deparment of Pediatric Cardiology, Saarland University Medical Center, Homburg, Germany
| | - Sebastian Maas
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany
| | - Ludwig Gortner
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany
| | - Martina Geipel
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany
| | - Michael Zemlin
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany
| | - Günther Löffler
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany
| | - Sascha Meyer
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany; Section Neuropediatrics, Saarland University Medical Center, Homburg, Germany.
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