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Boghossian NS, Mack NA, Bell EF, Tan S, Stoll BJ, Rysavy MA, Ambalavanan N, Tyson JE, Das A, Hintz SR. Trends in sex differences in neurodevelopmental outcomes among extremely preterm infants. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2024-327239. [PMID: 39288987 DOI: 10.1136/archdischild-2024-327239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 09/05/2024] [Indexed: 09/19/2024]
Abstract
OBJECTIVE To examine whether changes in survival without moderate or severe neurodevelopmental impairment (NDI) at 18-26 months' corrected age from 1999 to 2018 differed between male and female infants. DESIGN This retrospective cohort study used data from the NICHD Neonatal Research Network hospitals. Robust Poisson regression models were used to estimate adjusted relative risks (aRRs) and 95% CIs for survival without moderate or severe NDI between males and females. Interactions between sex and time were assessed to evaluate temporal differences in the outcome by sex. Variables adjusted for included centre, maternal age, ethnicity/race, gestational age and small for gestational age. PATIENTS Inborn infants with gestational age of 22-26 weeks at NICHD Neonatal Research Network hospitals from 1999 to 2018. MAIN OUTCOME MEASURE Change over time in survival without moderate or severe NDI at 18-26 months' corrected age between male and female infants. RESULTS Of 26 307 infants, 13 045 (49.6%) were male. Survival without moderate or severe NDI declined for both sexes over time, from 32.9% to 30.6% for males and from 47.4% to 40.0% for females, between 1999-2003 and 2014-2018. Males were less likely than females to survive without moderate or severe NDI (aRR=0.80; 95% CI 0.78 to 0.83). Changes in survival without moderate or severe NDI did not differ between males and females. CONCLUSION There were no differential changes in survival without moderate or severe NDI between male and female infants.
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Affiliation(s)
- Nansi S Boghossian
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Nicole A Mack
- Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, North Carolina, USA
| | - Edward F Bell
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Sylvia Tan
- Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, North Carolina, USA
| | - Barbara J Stoll
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Matthew A Rysavy
- Department of Pediatrics, University of Texas at Houston, Houston, Texas, USA
| | | | - Jon E Tyson
- Department of Pediatrics, University of Texas at Houston, Houston, Texas, USA
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, Maryland, USA
| | - Susan R Hintz
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California, USA
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2
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Sriram S, Jensen E, Msall M, Yi J, Zhabotynsky V, Joseph R, Kuban K, Frazier J, Hooper S, Santos H, Gogcu S, Shenberger J, Fry R, O'Shea T. Retinopathy of prematurity and neurodevelopmental outcome and quality of life at 10 years of age. RESEARCH SQUARE 2024:rs.3.rs-4324566. [PMID: 38766141 PMCID: PMC11100895 DOI: 10.21203/rs.3.rs-4324566/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Objective In a cohort of 10-year-old children born extremely preterm, we evaluated the hypothesis that increasing severity of retinopathy of prematurity (ROP) is associated with increasing frequency of unfavorable neurodevelopmental and quality of life outcomes. Study Design Study participants were classified according to the severity of ROP. At 10 years of age, their neurocognitive abilities, academic achievement, and gross motor function were assessed, and they were evaluated for autism spectrum disorder, anxiety, depression, and quality of life. Results After adjustment for sample attrition and confounders, only the association with lower quality of life persisted. Increasing severity of visual impairment was associated with worse neurodevelopmental outcomes and lower quality of life. Conclusion Among extremely preterm children, severity of visual impairment, but not severity of ROP, was associated with adverse neurodevelopmental outcomes at 10 years of age. Both severe ROP and more severe visual impairment were associated with lower quality of life.
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Affiliation(s)
| | | | | | - Joe Yi
- University of North Carolina School of Medicine
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3
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Barrett ES, Sullivan A, Workman T, Zhang Y, Loftus CT, Szpiro AA, Paquette A, MacDonald JW, Coccia M, Smith R, Bowman M, Smith A, Derefinko K, Nguyen RHN, Zhao Q, Sathyanarayana S, Karr C, LeWinn KZ, Bush NR. Sex-specific associations between placental corticotropin releasing hormone and problem behaviors in childhood. Psychoneuroendocrinology 2024; 163:106994. [PMID: 38387218 DOI: 10.1016/j.psyneuen.2024.106994] [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: 11/01/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/24/2024]
Abstract
Placental corticotropin-releasing hormone (pCRH) is a neuroactive peptide produced in high concentrations in mid-late pregnancy, during key periods of fetal brain development. Some evidence suggests that higher pCRH exposure during gestation is associated with adverse neurodevelopment, particularly in female offspring. In 858 mother-child dyads from the sociodemographically diverse CANDLE cohort (Memphis, TN), we examined: (1) the slope of pCRH rise in mid-late pregnancy and (2) estimated pCRH at delivery as a measure of cumulative prenatal exposure. When children were 4 years-old, mothers reported on problem behaviors using the Child Behavior Checklist (CBCL) and cognitive performance was assessed by trained psychologists using the Stanford-Binet Intelligence Scales. We fitted linear regression models examining pCRH in relation to behavioral and cognitive performance measures, adjusting for covariates. Using interaction models, we evaluated whether associations differed by fetal sex, breastfeeding, and postnatal neighborhood opportunity. In the full cohort, log-transformed pCRH measures were not associated with outcomes; however, we observed sex differences in some models (interaction p-values≤0.01). In male offspring, an interquartile (IQR) increase in pCRH slope (but not estimated pCRH at delivery), was positively associated with raw Total (β=3.06, 95%CI: 0.40, 5.72), Internalizing (β=0.89, 95%CI: 0.03, 1.76), and Externalizing (β=1.25, 95%CI: 0.27, 2.22) Problem scores, whereas, in females, all associations were negative (Total Problems: β=-1.99, 95%CI: -3.89, -0.09; Internalizing: β=-0.82, 95%CI: -1.42, -0.23; Externalizing: β=-0.56, 95%CI: -1.34, 0.22). No associations with cognitive performance were observed nor did we observe moderation by breastfeeding or postnatal neighborhood opportunity. Our results provide further evidence that prenatal pCRH exposure may impact subsequent child behavior in sex-specific ways, however in contrast to prior studies suggesting adverse impacts in females, steeper mid-gestation pCRH rise was associated with more problem behaviors in males, but fewer in females.
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Affiliation(s)
- Emily S Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA; Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, USA.
| | - Alexandra Sullivan
- Center for Health and Community, University of California, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Tomomi Workman
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Yuhong Zhang
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Christine T Loftus
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Adam A Szpiro
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Alison Paquette
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - James W MacDonald
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Michael Coccia
- Center for Health and Community, University of California, San Francisco, CA, USA
| | - Roger Smith
- Mothers and Babies Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Maria Bowman
- Mothers and Babies Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Alicia Smith
- Department of Gynecology and Obstetrics, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, USA
| | - Karen Derefinko
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Ruby H N Nguyen
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Qi Zhao
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Sheela Sathyanarayana
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Catherine Karr
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Kaja Z LeWinn
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Nicole R Bush
- Center for Health and Community, University of California, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA; Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
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4
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Janvier A, Bourque CJ, Pearce R, Thivierge E, Duquette LA, Jaworski M, Barrington KJ, Synnes AR, Church P, Luu TM. Fragility and resilience: parental and family perspectives on the impacts of extreme prematurity. Arch Dis Child Fetal Neonatal Ed 2023; 108:575-580. [PMID: 36997307 DOI: 10.1136/archdischild-2022-325011] [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: 12/11/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVES Extremely preterm babies have a significant risk of neurodevelopmental impairment (NDI). There has been little investigation regarding the impact of prematurity on families. The objective of this study was to explore parental perspectives regarding the impact of prematurity on themselves/their family. METHODS Over 1 year, parents of children born <29 weeks' gestational age (GA) who were between 18 months old and 7 years old and came for their follow-up visit were invited to participate. They were asked to categorise the impacts of prematurity on their life and their family as positive, negative or both and to describe those impacts in their own words. Thematic analysis was performed by a multidisciplinary group, including parents. Logistic regression was performed to compare parental responses. RESULTS Among parents (n=248, 98% participation rate), most (74%) reported that their child's prematurity had both positive and negative impacts on their life or their family's life, while 18% reported only positive impacts and 8% only negative impacts. These proportions were not correlated with GA, brain injury, nor level of NDI. The positive impacts reported included: an improved outlook on life, such as gratitude and perspective (48%), stronger family relationships (31%) and the gift of the child (28%). The negative themes were stress and fear (42%), loss of equilibrium due to medical fragility (35%) and concerns about developmental outcomes including the child's future (18%). CONCLUSION Parents report both positive and negative impacts after an extremely preterm birth, independent of disability. These balanced perspectives should be included in neonatal research, clinical care and provider education.
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Affiliation(s)
- Annie Janvier
- Department of Pediatrics and Clinical Ethics, Bureau de l'éthique clinique, Université de Montréal, Montreal, Quebec, Canada
- Neonatology, Palliative Care, Reserch Center, Unité d'éthique Clinique, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Claude Julie Bourque
- Department of Pediatrics, CHU Sainte-Justine Centre de Recherche, Montreal, Quebec, Canada
- Clinical Ethics and Family Partnership Research Unit, CHU Sainte-Justine Centre de Recherche, Montreal, Quebec, Canada
| | - Rebecca Pearce
- Parent Representative, Canadian Premature Baby Foundation, Montreal, Quebec, Canada
| | - Emilie Thivierge
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | | | - Magdalena Jaworski
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
- CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Keith J Barrington
- Department of Neonatology, Centre de Recherche, Centre Hospitalier Universitaire Sainte Justine, Montreal, Quebec, Canada
- Department of Pediatrics, Universite de Montreal, Montreal, Quebec, Canada
| | - Anne R Synnes
- Department of Neonatology, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Paige Church
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Thuy Mai Luu
- Department of Pediatrics, Universite de Montreal, Montreal, Quebec, Canada
- Pediatrics and Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
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5
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Handley SC, Kumbhat N, Eggleston B, Foglia EE, Davis AS, Van Meurs K, Lakshminrusimha S, Walsh M, Watterberg KL, Wyckoff MH, Das A, DeMauro SB. Exposure to umbilical cord management approaches and death or neurodevelopmental impairment at 22-26 months' corrected age after extremely preterm birth. Arch Dis Child Fetal Neonatal Ed 2023; 108:224-231. [PMID: 36253076 PMCID: PMC10108713 DOI: 10.1136/archdischild-2022-324565] [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: 06/21/2022] [Accepted: 09/25/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare death or severe neurodevelopmental impairment (NDI) at 22-26 months' corrected age (CA) among extremely preterm infants following exposure to different forms of umbilical cord management. DESIGN Retrospective study. SETTING Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network registry. PATIENTS Infants born <27 weeks' gestation in 2016-2018 without severe congenital anomalies who received active treatment after birth and underwent neurodevelopmental assessments between 22 and 26 months' CA. EXPOSURES Immediate cord clamping (ICC), delayed cord clamping (DCC) or umbilical cord milking (UCM). MAIN OUTCOMES AND MEASURE Primary composite outcome of death or severe NDI at 22-26 months' CA, defined as severe cerebral palsy, Bayley-III cognitive/motor composite score <70, bilateral deafness or blindness; individual components were examined as secondary outcomes. Multivariable regression examined associations, adjusting for risk factors identified a priori and potential confounders. Mediation analysis explored the effect of severe intraventricular haemorrhage (IVH) on the exposure-outcome relationship. RESULTS Among 1900 infants, 64.1% were exposed to ICC, 27.8% to DCC and 8.1% to UCM. Compared with ICC-exposed infants, DCC-exposed infants had lower odds of death or severe NDI (adjusted OR 0.64, 95% CI 0.50 to 0.83). No statistically significant differences were observed when comparing UCM with either ICC or DCC, or between secondary outcomes across groups. Association between cord management and the primary outcome was not mediated by severe IVH. CONCLUSION Compared with ICC, DCC exposure was associated with lower death or severe NDI at 22-26 months' CA among extremely preterm infants, which was not mediated by severe IVH.
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Affiliation(s)
- Sara C Handley
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Neha Kumbhat
- Pediatrics/Neonatology, Stanford University, Stanford, California, USA
| | - Barry Eggleston
- Biostatistics and Epidemiology, RTI International, Research Triangle Park, North Carolina, USA
| | - Elizabeth E Foglia
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexis S Davis
- Pediatrics/Neonatology, Stanford University, Stanford, California, USA
| | - Krisa Van Meurs
- Pediatrics/Neonatology, Stanford University, Stanford, California, USA
| | | | - Michele Walsh
- Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Kristi L Watterberg
- Department of Paediatrics, University of New Mexico, Albuquerque, New Mexico, USA
| | - Myra H Wyckoff
- Pediatrics, UT Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Abhik Das
- Biostatistics, RTI International, Rockville, Maryland, USA
| | - Sara B DeMauro
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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6
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Artificial intelligence in bronchopulmonary dysplasia- current research and unexplored frontiers. Pediatr Res 2023; 93:287-290. [PMID: 36385519 DOI: 10.1038/s41390-022-02387-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 10/21/2022] [Accepted: 10/30/2022] [Indexed: 11/17/2022]
Abstract
Provide an overview of bronchopulmonary dysplasia, its definitions, and their shortcomings. Explore the areas where machine learning may be used to further our understanding of bronchopulmonary dysplasia.
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7
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Kilbride HW, Vohr BR, McGowan EM, Peralta-Carcelen M, Stringer K, Das A, Archer SW, Hintz SR. Early neurodevelopmental follow-up in the NICHD neonatal research network: Advancing neonatal care and outcomes, opportunities for the future. Semin Perinatol 2022; 46:151642. [PMID: 35842320 PMCID: PMC11068160 DOI: 10.1016/j.semperi.2022.151642] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
At the inception of the Eunice Kennedy Shriver National Institute of Child Health and Development Neonatal Research Network (NRN), provision of care for extremely preterm (EPT) infants was considered experimental. The NRN Follow-up Study Group, initiated in 1993, developed infrastructure with certification processes and standards, allowing the NRN to assess 2-year outcomes for EPT and to provide important metrics for randomized clinical trials. This chapter will review the NRN Follow-up Study Group's contributions to understanding factors related to improved neurodevelopmental, behavioral, and social-emotional outcomes of EPT infants. We will also discuss follow up challenges, including reassessing which outcomes are most meaningful for parents and investigators. Finally, we will explore how outcome studies have informed clinical decisions and ethical considerations, given limitations of prediction of complex later childhood outcomes from early neurodevelopmental findings.
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Affiliation(s)
- Howard W Kilbride
- Department of Pediatrics, Children's Mercy-Kansas City and the University of Missouri-Kansas City, 2401 Gillham Road, 3rd Floor Annex, Kansas City, MO.
| | - Betty R Vohr
- Department of Pediatrics, Women and Infants Hospital of Rhode Island and Brown University, Providence, RI
| | - Elisabeth M McGowan
- Department of Pediatrics, Women and Infants Hospital of Rhode Island and Brown University, Providence, RI
| | | | - Kimberlly Stringer
- Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL
| | - Abhik Das
- Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, MD
| | - Stephanie Wilson Archer
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Susan R Hintz
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
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8
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Navidi A, De Boissieu P, Mannes I, Mokhtari M, Adamsbaum C. Periventricular hemorrhagic infarction (PVHI) associated with intraventricular hemorrhage (IVH) in premature infants: Outcome at 2 years of age. Arch Pediatr 2022; 29:459-466. [DOI: 10.1016/j.arcped.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/22/2022] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
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Ndukwe T, Cole E, Scanzera AC, Chervinko MA, Chiang MF, Campbell JP, Chan RVP. Health Equity and Disparities in ROP Care: A Need for Systematic Evaluation. Front Pediatr 2022; 10:806691. [PMID: 35433564 PMCID: PMC9010777 DOI: 10.3389/fped.2022.806691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/03/2022] [Indexed: 12/04/2022] Open
Abstract
Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder that can have devastating visual sequelae if not managed appropriately. From an ophthalmology standpoint, ROP care is complex, since it spans multiple care settings and providers, including those in the neonatal intensive care unit (NICU), step down nurseries, and the outpatient clinic setting. This requires coordination and communication between providers, ancillary staff, and most importantly, effective communication with the patient's family members and caregivers. Often, factors related to the social determinants of health play a significant role in effective communication and care coordination with the family, and it is important for ophthalmologists to recognize these risk factors. The aim of this article is to (1) review the literature related to disparities in preterm birth outcomes and infants at risk for ROP; (2) identify barriers to ROP care and appropriate follow up, and (3) describe patient-oriented solutions and future directions for improving ROP care through a health equity lens.
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Affiliation(s)
- Tochukwu Ndukwe
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
| | - Emily Cole
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
| | - Angelica C. Scanzera
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
| | - Margaret A. Chervinko
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
| | - Michael F. Chiang
- National Institutes of Health, National Eye Institute, Bethesda, MD, United States
| | - John Peter Campbell
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR, United States
| | - Robison Vernon Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
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10
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The Microbiota-Gut Axis in Premature Infants: Physio-Pathological Implications. Cells 2022; 11:cells11030379. [PMID: 35159189 PMCID: PMC8834399 DOI: 10.3390/cells11030379] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/22/2021] [Accepted: 01/17/2022] [Indexed: 11/16/2022] Open
Abstract
Intriguing evidence is emerging in regard to the influence of gut microbiota composition and function on host health from the very early stages of life. The development of the saprophytic microflora is conditioned by several factors in infants, and peculiarities have been found for babies born prematurely. This population is particularly exposed to a high risk of infection, postnatal antibiotic treatment, feeding difficulties and neurodevelopmental disabilities. To date, there is still a wide gap in understanding all the determinants and the mechanism behind microbiota disruption and its influence in the development of the most common complications of premature infants. A large body of evidence has emerged during the last decades showing the existence of a bidirectional communication axis involving the gut microbiota, the gut and the brain, defined as the microbiota–gut–brain axis. In this context, given that very few data are available to demonstrate the correlation between microbiota dysbiosis and neurodevelopmental disorders in preterm infants, increasing interest has arisen to better understand the impact of the microbiota–gut–brain axis on the clinical outcomes of premature infants and to clarify how this may lead to alternative preventive, diagnostic and therapeutic strategies. In this review, we explored the current evidence regarding microbiota development in premature infants, focusing on the effects of delivery mode, type of feeding, environmental factors and possible influence of the microbiota–gut–brain axis on preterm clinical outcomes during their hospital stay and on their health status later in life.
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11
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Reiss JD, Peterson LS, Nesamoney SN, Chang AL, Pasca AM, Marić I, Shaw GM, Gaudilliere B, Wong RJ, Sylvester KG, Bonifacio SL, Aghaeepour N, Gibbs RS, Stevenson DK. Perinatal infection, inflammation, preterm birth, and brain injury: A review with proposals for future investigations. Exp Neurol 2022; 351:113988. [DOI: 10.1016/j.expneurol.2022.113988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 01/06/2022] [Accepted: 01/13/2022] [Indexed: 11/26/2022]
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12
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Purposeful Language Exposure by Neonatal Nurses and Caregivers in the NICU. Adv Neonatal Care 2021; 21:407-417. [PMID: 34469368 DOI: 10.1097/anc.0000000000000833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Preterm infants are at significant risk of neurocognitive deficits including language delay. Extended hospitalization in the neonatal intensive care unit (NICU) causes missed opportunities for language exposure at critical developmental periods of neural pathways for language processing. Healthcare providers (HCPs), particularly nurses, may be instrumental in providing infant-directed speech to improve neurodevelopmental outcomes. PURPOSE To evaluate current evidence to determine what is known about the characteristics of HCP communication to infants in the NICU. SEARCH/STRATEGY Four databases and forward searching were used to respond to the clinical question: "What is known about the characteristics of HCP communication to infants in the NICU?" Empiric, primary research studies published in English without date restriction were included. FINDINGS Eight studies, primarily descriptive, were reviewed. Overall, infant-directed speech was rarely provided by HCPs. Language was more often directed to sicker infants, occurred in contexts of procedural pain, and was sometimes combined with touch. Perceptions of language by nurses, infants, and parents as well as inhibitors and benefits of infant-directed speech were reported. IMPLICATIONS FOR PRACTICE As frontline neonatal providers, nurses can serve as role models of infant-directed speech for parents, helping them gain comfort and understand the importance of speaking to their preterm infants. Nurses can also provide much-needed language nutrition to preterm infants when parents cannot be present. IMPLICATIONS FOR RESEARCH Methods to reduce barriers and support infant-directed speech in the NICU require testing. Predictive modeling using measures of language exposure in the NICU may support differences in neurodevelopmental outcomes.
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McCauley KE, Carey EC, Weaver AL, Mara KC, Clark RH, Carey WA, Collura CA. Survival of Ventilated Extremely Premature Neonates With Severe Intraventricular Hemorrhage. Pediatrics 2021; 147:e20201584. [PMID: 33727247 PMCID: PMC8015160 DOI: 10.1542/peds.2020-1584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Severe intraventricular hemorrhage (IVH) is a leading mortality risk factor among extremely premature neonates. Because other life-threatening conditions also occur in this population, it is unclear whether severe IVH is independently associated with death. The existence and potential implications of regional variation in severe IVH-associated mortality are unknown. METHODS We performed a retrospective cohort study of mechanically ventilated neonates born at 22 to 29 weeks' gestation who received care in 242 American NICUs between 2000 and 2014. After building groups composed of propensity score-matched and center-matched pairs, we used the Cox proportional hazards analysis to test our hypothesis that severe IVH would be associated with greater all-cause in-hospital mortality, defined as death before transfer or discharge. We also performed propensity score-matched subgroup analyses, comparing severe IVH-associated mortality among 4 geographic regions of the United States. RESULTS In our analysis cohort, we identified 4679 patients with severe IVH. Among 2848 matched pairs, those with severe IVH were more likely to die compared with those without severe IVH (hazard ratio 2.79; 95% confidence interval 2.49-3.11). Among 1527 matched pairs still hospitalized at 30 days, severe IVH was associated with greater risk of death (hazard ratio 2.03; 95% confidence interval 1.47-2.80). Mortality associated with severe IVH varied substantially between geographic regions. CONCLUSIONS The early diagnosis of severe IVH is independently associated with all-cause in-hospital mortality in extremely premature neonates. Regional variation in severe IVH-associated mortality suggests that shared decision-making between parents and neonatologists is strongly influenced by ultrasound-based IVH assessment and classification.
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Affiliation(s)
| | | | - Amy L Weaver
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota; and
| | - Kristin C Mara
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota; and
| | - Reese H Clark
- Center for Research, Education and Quality, Pediatrix Medical Group, Sunrise, Florida
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Emeruwa UN, Krenitsky NM, Sheen JJ. Advances in Management for Preterm Fetuses at Risk of Delivery. Clin Perinatol 2020; 47:685-703. [PMID: 33153655 DOI: 10.1016/j.clp.2020.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Preterm birth accounts for only 11% of live births but contributes to up to 75% of neonatal mortality and more than half of long-term morbidity. Targeted interventions to reduce the most common causes of perinatal morbidity and mortality include intrapartum group B Streptococcus prophylaxis, magnesium sulfate for fetal neuroprotection, antenatal corticosteroids for fetal lung maturity, latency antibiotics for preterm premature rupture of membranes, and tocolysis to allow corticosteroid administration and transfer to a tertiary care center. This article reviews the evidence for interventions to improve outcomes for fetuses at risk for preterm delivery at different gestational ages.
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Affiliation(s)
- Ukachi N Emeruwa
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, 622 East 168th Street PH 16-66, New York, NY 10032, USA. https://twitter.com/MissUkachi
| | - Nicole M Krenitsky
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, 622 East 168th Street PH 16-66, New York, NY 10032, USA
| | - Jean-Ju Sheen
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, 622 East 168th Street PH 16-66, New York, NY 10032, USA.
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15
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Nam YS, Heo JS, Byeon JH, Lee EH. Neurodevelopmental Outcomes of Moderate-to-Late Preterm Infants. NEONATAL MEDICINE 2020. [DOI: 10.5385/nm.2020.27.4.159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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16
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Chee YY, Wong RMS, Wong MSC, Tso WWY, Wong WHS, Lee SL. Changes in Mortality and Cerebral Palsy in Extremely Low-Birth-Weight Infants in a Tertiary Center in Hong Kong. Glob Pediatr Health 2020; 7:2333794X20901932. [PMID: 32030351 PMCID: PMC6977223 DOI: 10.1177/2333794x20901932] [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: 10/09/2019] [Revised: 12/02/2019] [Accepted: 12/18/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction. We retrospectively reviewed a cohort of extremely low-birth-weight (ELBW) babies born at Queen Mary Hospital and explored if there is any time trend in survival and short-term neurodevelopmental outcomes. Methods. We included ELBW infants born at Queen Mary Hospital between 2008 and 2015. The relationships between multiple risk factors with survival and neurodevelopmental outcomes were analyzed by either Cox regression or univariate logistic regression analysis. We also compared this birth-year period with our previous study from 1993 to 2002. Results. Two hundred seventeen ELBW infants were delivered during the study period. There was significantly higher overall survival rate (81.1%) in 2008 to 2015 compared with 71.4% in 1993 to 2002. One hundred forty-three out of 176 (81%) survivors were assessed at a corrected mean age of 18.1 months. A total of 4.2% had cerebral palsy. There were significantly lower rates of cerebral palsy in 2008 to 2015 (4.2%) compared with 1993 to 2002 (13.5%). Conclusions. We showed a temporal improvement in survival and short-term neurodevelopmental outcomes.
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Ramani M, Miller K, Brown J, Kumar R, Kadasamy J, McMahon L, Ballinger S, Ambalavanan N. Early Life Supraphysiological Levels of Oxygen Exposure Permanently Impairs Hippocampal Mitochondrial Function. Sci Rep 2019; 9:13364. [PMID: 31527593 PMCID: PMC6746707 DOI: 10.1038/s41598-019-49532-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/27/2019] [Indexed: 01/24/2023] Open
Abstract
Preterm infants requiring prolonged oxygen therapy often develop cognitive dysfunction in later life. Previously, we reported that 14-week-old young adult mice exposed to hyperoxia as newborns had spatial and learning deficits and hippocampal shrinkage. We hypothesized that the underlying mechanism was the induction of hippocampal mitochondrial dysfunction by neonatal hyperoxia. C57BL/6J mouse pups were exposed to 85% oxygen or room air from P2-P14. Hippocampal proteomic analysis was performed in young adult mice (14 weeks). Mitochondrial bioenergetics were measured in neonatal (P14) and young adult mice. We found that hyperoxia exposure reduced mitochondrial ATP-linked oxygen consumption and increased state 4 respiration linked proton leak in both neonatal and young adult mice while complex I function was decreased at P14 but increased in young adult mice. Proteomic analysis revealed that hyperoxia exposure decreased complex I NDUFB8 and NDUFB11 and complex IV 7B subunits, but increased complex III subunit 9 in young adult mice. In conclusion, neonatal hyperoxia permanently impairs hippocampal mitochondrial function and alters complex I function. These hippocampal mitochondrial changes may account for cognitive deficits seen in children and adolescents born preterm and may potentially be a contributing mechanism in other oxidative stress associated brain disorders.
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Affiliation(s)
- Manimaran Ramani
- Departments of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, 35233, USA.
| | - Kiara Miller
- Departments of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Jamelle Brown
- Departments of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Ranjit Kumar
- Departments of Bioinformatics, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Jegen Kadasamy
- Departments of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Lori McMahon
- Departments of cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
- Departments of Neurobiology, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Scott Ballinger
- Departments of Pathology, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Namasivayam Ambalavanan
- Departments of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
- Departments of cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
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18
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Haragan AF, Zuwiala CA, Himes KP. Online Information About Periviable Birth: Quality Assessment. JMIR Pediatr Parent 2019; 2:e12524. [PMID: 31518325 PMCID: PMC6716431 DOI: 10.2196/12524] [Citation(s) in RCA: 5] [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: 11/07/2018] [Revised: 03/29/2019] [Accepted: 04/26/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Over 20,000 parents in the United States face the challenge of participating in decisions about whether to use life support for their infants born on the cusp of viability every year. Clinicians must help families grasp complex medical information about their baby's immediate prognosis as well as the risk for significant long-term morbidity. Patients faced with this decision want supplemental information and frequently seek medical information on the Internet. Empirical evidence about the quality of websites is lacking. OBJECTIVE We sought to evaluate the quality of online information available about periviable birth and treatment options for infants born at the cusp of viability. METHODS We read a counseling script to 20 pregnant participants that included information typically provided by perinatal and neonatal providers when periviable birth is imminent. The women were then asked to list terms they would use to search the Internet if they wanted additional information. Using these search terms, two reviewers evaluated the content of websites obtained via a Google search. We used two metrics to assess the quality of websites. The first was the DISCERN instrument, a validated questionnaire designed to assess the quality of patient-targeted health information for treatment choices. The second metric was the Essential Content Tool (ECT), a tool designed to address key components of counseling around periviable birth as outlined by professional organizations. DISCERN scores were classified as low quality if scores were 2, fair quality if scores were 3, and high quality if scores were 4 or higher. Scores of 6 or higher on the ECT were considered high quality. Interreviewer agreement was assessed by calculated kappa statistic. RESULTS A total of 97 websites were reviewed. Over half (57/97, 59%) were for-profit sites, news stories, or personal blogs; 28% (27/97) were government or medical sites; and 13% (13/97) were nonprofit or advocacy sites. The majority of sites scored poorly in DISCERN questions designed to assess the reliability of information presented as well as data regarding treatment choices. Only 7% (7/97) of the websites were high quality as defined by the DISCERN tool. The majority of sites did not address the essential content defined by the ECT. Importantly, only 18% of websites (17/97) indicated that there are often a number of reasonable approaches to newborn care when faced with periviable birth. Agreement was strong, with kappa ranging from .72 to .91. CONCLUSIONS Most information about periviable birth found on the Internet using common search strategies is of low quality. News stories highlighting positive outcomes are disproportionately represented. Few websites discuss comfort care or how treatment decisions impact quality of life.
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Affiliation(s)
- Adriane F Haragan
- Department of Obstetrics and Gynecology, Kalispell Regional Healthcare, Kalispell, MT, United States
| | - Carly A Zuwiala
- Department of Obstetrics and Gynecology, Magee-Womens Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - Katherine P Himes
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, United States
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Neurobehavior of preterm infants from 32 to 48 weeks post-menstrual age. J Perinatol 2019; 39:800-807. [PMID: 30962584 DOI: 10.1038/s41372-019-0376-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 11/08/2022]
Abstract
AIM Evaluate prospectively the neurobehavior of preterm infants (PT). STUDY DESIGN Cohort of PT (gestational age(GA) <32weeks), evaluated biweekly from 32 to 48 weeks post-menstrual age (PMA) by NICU Network Neurobehavioral Scale (NNNS). Scores were compared by repeated Measures ANOVA. Scores of PT were compared to those of full-term infants, matched for gender by ANOVA. RESULTS 39 PT (mean ± SD: GA 29.2 ± 2.0 weeks; birthweight 1100 ± 331g) were studied. As PMA progressed, PT showed increasing scores in habituation, attention, arousal, regulation, maneuvers for orientation, quality of movements and hypertonicity, and decreasing scores in excitability, lethargy, non-optimal reflexes, asymmetry, hypotonicity, and signs of stress/withdrawal. At 40 weeks PMA, PT were similar to term neonates assessed in the first days of life, except for less habituation, regulation capacity and excitability, and more hypotonia. CONCLUSION At 40 weeks PMA, PT reached the performance of full-term neonates evaluated in the first days of life in most neurobehavior domains.
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20
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Abstract
There is increasing evidence of ongoing changes occurring in short-term and long-term motor and language outcomes in former premature infants. As rates of moderate to severe cerebral palsy (CP) have decreased, there has been increased awareness of the impact of mild CP and of developmental coordination disorder on the preterm population. Language delays and disorders continue to be among the most common outcomes. In conjunction with medical morbidities, there is increased awareness of the negative impact of family psycho-socioeconomic adversities on preterm outcomes and of the importance of intervention for these adversities beginning in the neonatal ICU.
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21
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Inoue H, Ochiai M, Sakai Y, Yasuoka K, Tanaka K, Ichiyama M, Kurata H, Fujiyoshi J, Matsushita Y, Honjo S, Nonaka K, Taguchi T, Kato K, Ohga S. Neurodevelopmental Outcomes in Infants With Birth Weight ≤500 g at 3 Years of Age. Pediatrics 2018; 142:peds.2017-4286. [PMID: 30446630 DOI: 10.1542/peds.2017-4286] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine neurodevelopmental outcomes at 3 years of age in children born with a birth weight (BW) of ≤500 g. METHODS Infants who were born with a BW of ≤500 g from 2003 to 2012 in the Neonatal Research Network of Japan and survived to discharge from the NICU were eligible in this study. The study population consisted of 460 children (56.7% of 811 surviving infants) who were evaluated at 36 to 42 months of age. Neurodevelopmental impairment (NDI) was defined as having cerebral palsy, visual impairment, hearing impairment, or a developmental quotient score of <70. RESULTS The overall proportion of NDI was 59.1% (95% confidence interval [CI]: 54.6%-63.5%). The trend revealed no significant change during the study period. In a multivariate modified Poisson regression analysis, NDI was associated with severe intraventricular hemorrhage (adjusted risk ratio [RR]: 1.42; 95% CI: 1.19-1.68; P < .01), cystic periventricular leukomalacia (adjusted RR: 1.40; 95% CI: 1.13-1.73; P < .01), severe necrotizing enterocolitis (adjusted RR: 1.31; 95% CI: 1.07-1.60; P < .01), surgical ligation for patent ductus arteriosus (adjusted RR: 1.29; 95% CI: 1.09-1.54; P < .01), and male sex (adjusted RR: 1.19; 95% CI: 1.01-2.40; P = .04). CONCLUSIONS This cohort showed that neurodevelopmental outcomes of infants with a BW of ≤500 g have not improved from 2003 to 2012. Multivariate analysis revealed that severe intracranial hemorrhage and cystic periventricular leukomalacia were the strongest risk factors for NDIs. Our data suggested that measures aimed at reducing neurologic morbidities will be important for improving outcomes of infants with a BW of ≤500 g.
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Affiliation(s)
- Hirosuke Inoue
- Department of Pediatrics, Graduate School of Medical Sciences and .,Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan; and
| | - Masayuki Ochiai
- Department of Pediatrics, Graduate School of Medical Sciences and.,Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan; and
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences and.,Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan; and
| | - Kazuaki Yasuoka
- Department of Pediatrics, Graduate School of Medical Sciences and.,Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan; and
| | - Koichi Tanaka
- Department of Pediatrics, Graduate School of Medical Sciences and.,Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan; and
| | - Masako Ichiyama
- Department of Pediatrics, Graduate School of Medical Sciences and.,Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan; and
| | - Hiroaki Kurata
- Department of Pediatrics, Graduate School of Medical Sciences and.,Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan; and
| | - Junko Fujiyoshi
- Department of Pediatrics, Graduate School of Medical Sciences and.,Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan; and
| | - Yuki Matsushita
- Department of Pediatrics, Graduate School of Medical Sciences and.,Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan; and
| | - Satoshi Honjo
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Kazuaki Nonaka
- Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan; and
| | - Tomoaki Taguchi
- Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan; and
| | - Kiyoko Kato
- Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan; and
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences and.,Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan; and
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Abstract
Bronchopulmonary dysplasia (BPD) is a common complication of extreme prematurity, and its rate is not improving, despite advances in perinatal intensive care. Children with BPD diagnosed in the neonatal period have higher risks for hospitalizations for respiratory problems over the first few years of life, and they have more asthma in later childhood. Neonates diagnosed with BPD have substantial airway obstruction on lung function testing in later childhood and early adulthood, and many are destined to develop adult chronic obstructive pulmonary disease. Survivors with neonatal BPD have more adverse motor function, worse cognitive development and poorer academic progress than those without BPD. Long-term outcomes for children born extremely preterm will improve if the rate of BPD can be substantially reduced.
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Affiliation(s)
- Jeanie L Y Cheong
- Neonatal Services, Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Lex W Doyle
- Neonatal Services, Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Targeting the gut microbiota to influence brain development and function in early life. Neurosci Biobehav Rev 2018; 95:191-201. [PMID: 30195933 DOI: 10.1016/j.neubiorev.2018.09.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 12/16/2022]
Abstract
In the first 2-3 years of life, the gut microbiota of infants quickly becomes diverse and rich. Disruptions in the evolving gut microbiota during this critical developmental period can impact brain development. Communication between the microbiota, gut and brain is driven by hormonal and neural regulation, as well as immune and metabolic pathways, however, our understanding of how the parallel developments that may underlie this communication are limited. In this paper, we review the known associations between the gut microbiota and brain development and brain function in early life, speculate on the potential mechanisms involved in this complex relationship and describe how nutritional intervention can further modulate the microbiota and, ultimately, brain development and function.
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24
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Supraphysiological Levels of Oxygen Exposure During the Neonatal Period Impairs Signaling Pathways Required for Learning and Memory. Sci Rep 2018; 8:9914. [PMID: 29967535 PMCID: PMC6028393 DOI: 10.1038/s41598-018-28220-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/04/2018] [Indexed: 12/31/2022] Open
Abstract
Preterm infants often require prolonged oxygen supplementation and are at high risk of neurodevelopmental impairment. We recently reported that adult mice exposed to neonatal hyperoxia (postnatal day [P] 2 to 14) had spatial navigation memory deficits associated with hippocampal shrinkage. The mechanisms by which early oxidative stress impair neurodevelopment are not known. Our objective was to identify early hyperoxia-induced alterations in hippocampal receptors and signaling pathways necessary for memory formation. We evaluated C57BL/6 mouse pups at P14, exposed to either 85% oxygen or air from P2 to 14. We performed targeted analysis of hippocampal ligand-gated ion channels and proteins necessary for memory formation, and global bioinformatic analysis of differentially expressed hippocampal genes and proteins. Hyperoxia decreased hippocampal mGLU7, TrkB, AKT, ERK2, mTORC1, RPS6, and EIF4E and increased α3, α5, and ɤ2 subunits of GABAA receptor and PTEN proteins, although changes in gene expression were not always concordant. Bioinformatic analysis indicated dysfunction in mitochondria and global protein synthesis and translational processes. In conclusion, supraphysiological oxygen exposure reduced proteins necessary for hippocampus-dependent memory formation and may adversely impact hippocampal mitochondrial function and global protein synthesis. These early hippocampal changes may account for memory deficits seen in preterm survivors following prolonged oxygen supplementation.
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25
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Outcomes and related factors in a cohort of infants born in Taiwan over a period of five years (2007–2011) with borderline viability. J Formos Med Assoc 2018; 117:365-373. [DOI: 10.1016/j.jfma.2018.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 12/15/2017] [Accepted: 01/24/2018] [Indexed: 12/17/2022] Open
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Lee M, Pascoe JM, McNicholas CI. Reading, Mathematics and Fine Motor Skills at 5 Years of Age in US Children who were Extremely Premature at Birth. Matern Child Health J 2018; 21:199-207. [PMID: 27423237 DOI: 10.1007/s10995-016-2109-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives The prevalence of extreme prematurity at birth has increased, but little research has examined its impact on developmental outcomes in large representative samples within the United States. This study examined the association of extreme prematurity with kindergarteners' reading skills, mathematics skills and fine motor skills. Methods The early childhood longitudinal study-birth cohort, a representative sample of the US children born in 2001 was analyzed for this study. Early reading and mathematics skills and fine motor skills were compared among 200 extremely premature children (EPC) (gestational age <28 wks or birthweight <1000 g), 500 premature children (PC), and 4300 term children (TC) (≥37wks or ≥2500 g). Generalized linear regression analyses included sampling weights, children's age, race, sex, and general health status, and parental marital status and education among singleton children. Results At age 5 years, EPC were 2.6(95 % CI 1.7-3.8) times more likely to fail build a gate and were 3.1(95 % CI 1.6-5.8) times more likely to fail all four drawing tasks compared to TC (p values <0.001). Fine motor performance of PC (failed to build a gate, 1.3[95 % CI 1.0-1.7]; failed to draw all four shapes, 1.1[95 % CI 0.8-1.6]) was not significantly different from TC. Mean early reading scale score (36.8[SE:1.3]) of EPC was 4.0 points lower than TC (p value < 0.0001) while mean reading score (39.9[SE:1.4]) of PC was not significantly different from TC (40.8[SE:1.1]). Mean mathematics scale score were significantly lower for both EPC (35.5[SE:1.0], p value < 0.001) and PC (39.8[SE:0.8], p value = 0.023) compared to TC (41.0[SE:0.6]). Conclusions for Practice Extreme prematurity at birth was associated with cognitive and fine motor delays at age 5 years. This suggests that based on a nationally representative sample of infants, the biological risk of extreme prematurity persists after adjusting for other factors related to development.
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Affiliation(s)
- Miryoung Lee
- Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA. .,Department of Community Health, Lifespan Health Research Center, Boonshoft School of Medicine, Wright State University, 3171 Research Blvd, Dayton, OH, 45420, USA.
| | - John M Pascoe
- Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Caroline I McNicholas
- Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
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27
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Spittle AJ, Cameron K, Doyle LW, Cheong JL. Motor Impairment Trends in Extremely Preterm Children: 1991-2005. Pediatrics 2018; 141:peds.2017-3410. [PMID: 29567814 DOI: 10.1542/peds.2017-3410] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There are increasing numbers of surviving children who were born extremely preterm (EP; gestational age <28 weeks) or extremely low birth weight (ELBW; birth weight <1000 g). Our objective in this study was to compare the rates of motor impairment at 8 years of age between 3 cohorts of EP and/or ELBW and term-born children to establish if motor impairment rates are changing over time. METHODS All children born EP and/or ELBW in the calendar years of 1991-1992, 1997, and 2005 in Victoria, Australia, were recruited at birth. Randomly selected normal birth weight (>2499 g) and term-born controls were matched for expected date of birth, sex, and sociodemographic status. At 8 years' corrected age, motor impairment was defined as cerebral palsy (CP) or a score less than the fifth centile on the Movement Assessment Battery for Children for the 1991-1992 and 1997 cohorts and less than or equal to the fifth centile on the Movement Assessment Battery for Children-Second Edition for the 2005 cohort. RESULTS Motor impairment was more likely in children born EP and/or ELBW compared with children born at term for all epochs. There was a significant increase in motor impairment in EP and/or ELBW children over the 3 eras, from 23% in 1991-1992 and 26% in 1997 to 37% in 2005 (χ2trend = 10.2; P = .001). This was due to an increase in non-CP motor impairment (13% in 1991 to 1992; 15% in 1997; 26% in 2005; χ2trend = 12.5; P < .001), not CP (11% in 1991 to 1992; 11% in 1997; 12% in 2005). CONCLUSIONS The rate of motor impairment in EP and/or ELBW children assessed at 8 years of age increased between eras, an increase caused by non-CP motor impairment.
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Affiliation(s)
- Alicia J Spittle
- Department of Physiotherapy, Melbourne School of Health Sciences, and .,Neonatal Services, The Royal Women's Hospital, Melbourne, Australia; and.,Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
| | - Kate Cameron
- Department of Physiotherapy, Melbourne School of Health Sciences, and.,Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
| | - Lex W Doyle
- Neonatal Services, The Royal Women's Hospital, Melbourne, Australia; and.,Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia.,Departments of Obstetrics and Gynaecology and.,Paediatrics, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Jeanie L Cheong
- Neonatal Services, The Royal Women's Hospital, Melbourne, Australia; and.,Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia.,Departments of Obstetrics and Gynaecology and
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Malavolti AM, Bassler D, Arlettaz-Mieth R, Faldella G, Latal B, Natalucci G. Bronchopulmonary dysplasia-impact of severity and timing of diagnosis on neurodevelopment of preterm infants: a retrospective cohort study. BMJ Paediatr Open 2018; 2:e000165. [PMID: 29637181 PMCID: PMC5842992 DOI: 10.1136/bmjpo-2017-000165] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/20/2017] [Accepted: 12/12/2017] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To assess the contribution of the severity of bronchopulmonary dysplasia (BPD) and the time point of its diagnosis to the prediction of neurodevelopmental impairment (NDI) at corrected age of 2 years in preterm infants. DESIGN Retrospective cohort study. SETTING Level-III perinatal centre. PATIENTS AND OUTCOME MEASURES Infants born in 2000-2013 with gestational age <30 weeks. BPD was defined as FiO2 >21% for ≥28 days and its severity classified as mild, FiO2=21%; moderate, FiO2 <30% and severe, FiO2 ≥30% and/or positive pressure support. We applied these criteria at two time points: 36 and 40 weeks' postmenstrual age (PMA). Multivariable regression models were used to estimate the association (OR (95% CI)) between BPD characteristics and NDI defined as cognitive or motor development score <2 SD; severe cerebral palsy; deafness and blindness. RESULTS Of 610 (81% of cohort) children assessed at 2 years, 357 (58%) had BPD and 98 (16%) had NDI. Neither FiO2 >21% for ≥28 days nor mild or moderate BPD at either 36 or 40 weeks' PMA was associated with NDI, but severe BPD was (at 36 weeks' PMA 5.6 (2.0 to 16.0) and at 40 weeks' PMA 16.6 (4.6 to 59.9)). Infants with severe BPD at both 36 and 40 weeks' PMA had lower mental (mean difference -11.4 (-18.5 to -4.3), -25.7(-35.9 to -15.5), respectively) and motor (-7.8 (-14.9 to -0.6), -20.1(-30.7 to -9.5), respectively), developmental scores than infants without BPD. CONCLUSION In this cohort, severe BPD was a better independent predictor of NDI at 2 years than mild or moderate BPD. BPD diagnosed at 40 weeks' PMA might allow better identification of infants at highest risk for NDI.
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Affiliation(s)
- Anna Maria Malavolti
- Department of Neonatology, University of Zurich and Zurich University Hospital, Zurich, Switzerland.,Department of Gynaecological, Obstetric and Paediatric Sciences, University Hospital of Bologna, Bologna, Italy
| | - Dirk Bassler
- Department of Neonatology, University of Zurich and Zurich University Hospital, Zurich, Switzerland
| | - Romaine Arlettaz-Mieth
- Department of Neonatology, University of Zurich and Zurich University Hospital, Zurich, Switzerland
| | - Giacomo Faldella
- Department of Gynaecological, Obstetric and Paediatric Sciences, University Hospital of Bologna, Bologna, Italy
| | - Beatrice Latal
- Child Development Centre, Zurich University Children's Hospital, Zurich, Switzerland
| | - Giancarlo Natalucci
- Department of Neonatology, University of Zurich and Zurich University Hospital, Zurich, Switzerland.,Child Development Centre, Zurich University Children's Hospital, Zurich, Switzerland
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29
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Lawrence SM, Wynn JL. Chorioamnionitis, IL-17A, and fetal origins of neurologic disease. Am J Reprod Immunol 2017; 79:e12803. [PMID: 29271527 DOI: 10.1111/aji.12803] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 11/28/2017] [Indexed: 12/23/2022] Open
Abstract
The Centers for Disease Control and Prevention estimate that 1 in 323 infants have cerebral palsy. Highly correlated to intrauterine infection and inflammation, the incidence of cerebral palsy has remained constant over the last few decades despite significant advances in neonatal intensive care including improved ventilator techniques, surfactant therapy, maternal steroid administration, and use of intrapartum empiric antimicrobials. Recent advances in our understanding of immune responses to infection and inflammation have identified the cytokine IL-17A as a crucial component of early proinflammatory mediators that cause brain injury associated with neurologic impairment. Remarkably, maternal inflammatory responses to in utero inflammation and infection can also lead to potentially debilitating neurologic conditions in the offspring, which often become clinically apparent during childhood and/or early adulthood. This review details the role of IL-17A in fetal and maternal proinflammatory responses that lead to fetal brain injury and neurologic sequelae, including cerebral palsy. Recent findings regarding the role of maternal inflammatory responses in the development of childhood and adult neurologic conditions, such as autism, schizophrenia, and multiple sclerosis, will also be highlighted.
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Affiliation(s)
- Shelley M Lawrence
- College of Medicine, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of California, San Diego, CA, USA.,Department of Pediatrics, Division of Host-Microbe Systems and Therapeutics, University of California, San Diego, CA, USA
| | - James L Wynn
- College of Medicine, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Florida, Gainesville, FL, USA.,Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL, USA
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30
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Abstract
"Golden Hour" of neonatal life is defined as the first hour of post-natal life in both preterm and term neonates. This concept in neonatology has been adopted from adult trauma where the initial first hour of trauma management is considered as golden hour. The "Golden hour" concept includes practicing all the evidence based intervention for term and preterm neonates, in the initial sixty minutes of postnatal life for better long-term outcome. Although the current evidence supports the concept of golden hour in preterm and still there is no evidence seeking the benefit of golden hour approach in term neonates, but neonatologist around the globe feel the importance of golden hour concept equally in both preterm and term neonates. Initial first hour of neonatal life includes neonatal resuscitation, post-resuscitation care, transportation of sick newborn to neonatal intensive care unit, respiratory and cardiovascular support and initial course in nursery. The studies that evaluated the concept of golden hour in preterm neonates showed marked reduction in hypothermia, hypoglycemia, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). In this review article, we will discuss various components of neonatal care that are included in "Golden hour" of preterm and term neonatal care.
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Affiliation(s)
- Deepak Sharma
- National Institute of Medical Science, Jaipur, Rajasthan India
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31
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Greenberg RG, Kandefer S, Do BT, Smith PB, Stoll BJ, Bell EF, Carlo WA, Laptook AR, Sánchez PJ, Shankaran S, Van Meurs KP, Ball MB, Hale EC, Newman NS, Das A, Higgins RD, Cotten CM. Late-onset Sepsis in Extremely Premature Infants: 2000-2011. Pediatr Infect Dis J 2017; 36:774-779. [PMID: 28709162 PMCID: PMC5627954 DOI: 10.1097/inf.0000000000001570] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Late-onset sepsis (LOS) is an important cause of death and neurodevelopmental impairment in premature infants. The purpose of this study was to assess overall incidence of LOS, distribution of LOS-causative organisms and center variation in incidence of LOS for extremely premature infants over time. METHODS In a retrospective analysis of infants 401-1000 g birth weight and 22-28 6/7 weeks of gestational age born at 12 National Institute of Child Health and Human Development Neonatal Research Network centers in the years 2000-2005 (era 1) or 2006-2011 (era 2) who survived >72 hours, we compared the incidence of LOS and pathogen distribution in the 2 eras using the χ test. We also examined the effect of birth year on the incidence of LOS using multivariable regression to adjust for nonmodifiable risk factors and for center. To assess whether the incidence of LOS was different among centers in era 2, we used a multivariable regression model to adjust for nonmodifiable risk factors. RESULTS Ten-thousand one-hundred thirty-one infants were studied. LOS occurred in 2083 of 5031 (41%) infants in era 1 and 1728 of 5100 (34%) infants in era 2 (P < 0.001). Birth year was a significant predictor of LOS on adjusted analysis, with birth years 2000-2009 having a significantly higher odds of LOS than the reference year 2011. Pathogens did not differ, with the exception of decreased fungal infection (P < 0.001). In era 2, 9 centers had significantly higher odds of LOS compared with the center with the lowest incidence. CONCLUSIONS The incidence of LOS decreased over time. Further investigation is warranted to determine which interventions have the greatest impact on infection rates.
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Affiliation(s)
- Rachel G. Greenberg
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Sarah Kandefer
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC
| | - Barbara T. Do
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC
| | - P. Brian Smith
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Barbara J. Stoll
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA
| | - Edward F. Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Waldemar A. Carlo
- Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL
| | - Abbot R. Laptook
- Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI
| | - Pablo J. Sánchez
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Krisa P. Van Meurs
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, CA
| | - M. Bethany Ball
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, CA
| | - Ellen C. Hale
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA
| | - Nancy S. Newman
- Department of Pediatrics, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD
| | - Rosemary D. Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - C. Michael Cotten
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
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32
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Kaczmarczyk K, Wiszomirska I, Szturmowicz M, Magiera A, Błażkiewicz M. Are preterm-born survivors at risk of long-term respiratory disease? Ther Adv Respir Dis 2017; 11:277-287. [PMID: 28614994 PMCID: PMC5933633 DOI: 10.1177/1753465817710595] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 04/21/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To evaluate the long-term impact of preterm birth on respiratory function in female patients born preterm, we undertook spirometric examinations twice, as they reached the age of puberty, then follow-up examinations of part of the same cohort in adulthood. We sought evidence that preterm birth is correlated with poorer spirometric results into adulthood. METHODS A total of 70 girls (aged 12.2 ± 1.5 years in 1997) who had been born preterm (at 34.7 ± 1.86 weeks, none having experienced bronchopulmonary dysplasia) took part in spriometric examinations in 1997 and again in 1998. Of those, after a gap of 17 years, a group of 12 were successfully recontacted and participated in the 2015 examination as adults (then aged 27.6 ± 2.6 years, born at 34.5 ± 1.92 weeks). We compared spirometric results across the adolescent and adult examinations, and compared the adult results with an adult reference group. RESULTS The percentage values of FEV1 (forced expiratory volume in 1 s), FVC (forced vital capacity) and MVV (maximal voluntary ventilation) showed significant improvement between the two examinations in the early adolescent period. In adulthood, FEV1%pred (percentage predicted forced expiratory volume in 1 s) showed no statistically significant difference. The mean values of both FVC and FVC%pred (percentage predicted forced vital capacity) for the preterm-born group were lower than for the reference group, but this was not statistically significant. The preterm-born group showed lower values of such parameters as forced expiratory flow at 25-75% of FVC, MEF25 (maximal expiratory flow at 25% of forced vital capacity) and FEV1/FVC as compared with the reference group, but again without statistical significance. CONCLUSIONS (1) A somewhat below-norm level of respiratory parameters among preterm-born girls entering pubescence may attest to continued negative impact on their respiratory system. (2) A significant improvement in their spirometric results 1 year later may indicate that pubescence helps compensate for the earlier negative effect of preterm birth. (3) No significant differences were seen in lung function in preterm-born adults as compared with a reference group of adults, although the preterm-born group did exhibit lower values of all parameters studied and more frequent obstructive disorders.
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Affiliation(s)
- Katarzyna Kaczmarczyk
- Head of Physiology Department, Faculty of
Rehabilitation, Józef Piłsudski University of Physical Education in Warsaw,
Marymoncka 34 Street, Warsaw, Poland
| | - Ida Wiszomirska
- Józef Piłsudski University of Physical Education
in Warsaw, Faculty of Rehabilitation, Warsaw, Poland
| | - Magdalena Szturmowicz
- Józef Piłsudski University of Physical Education
in Warsaw, Faculty of Rehabilitation, Warsaw, Poland
| | - Andrzej Magiera
- Józef Piłsudski University of Physical Education
in Warsaw, Faculty of Rehabilitation, Warsaw, Poland
| | - Michalina Błażkiewicz
- Józef Piłsudski University of Physical Education
in Warsaw, Faculty of Rehabilitation, Warsaw, Poland
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33
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Asami M, Kamei A, Nakakarumai M, Shirasawa S, Akasaka M, Araya N, Tanifuji S, Chida S. Intellectual outcomes of extremely preterm infants at school age. Pediatr Int 2017; 59:570-577. [PMID: 27935152 DOI: 10.1111/ped.13215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 11/14/2016] [Accepted: 11/22/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The survival rate of extremely preterm (EP) infants (<28 weeks of gestation) has improved dramatically, and there is great interest in the long-term prognosis. The aim of this study was to elucidate the influence of prenatal and postnatal care on long-term intellectual outcome in EP infants. METHODS Subjects were EP infants admitted to the neonatal intensive care unit from 1982 to 2005. The survival rate and neurodevelopmental outcomes at 6 years of age were analyzed for the periods 1982-1991 (period 1) and 1992-2005 (period 2). Logistic regression analysis was performed to examine risk factors for intellectual impairment. RESULTS Survival rate improved significantly from 84.5% (period 1) to 92.4% (period 2; P = 0.007). Follow-up data were obtained from 92 children in period 1 (69.7% of survivors) and from 245 in period 2 (72.3% of survivors). The incidence of intellectual impairment increased from 16.3% (period 1) to 31.0% (period 2). Significant factors associated with intellectual impairment were period 2 (OR, 3.53; P = 0.007), supplemental oxygen at 36 weeks' corrected age (OR, 2.22; P = 0.012), number of days in the hospital (OR, 1.01; P = 0.012), intraventricular hemorrhage (IVH; OR, 3.05; P = 0.024), and later tube-feeding commencement date (OR, 1.10; P = 0.032). CONCLUSIONS Despite an increase in survival rate, the rate of intellectual impairment increased in period 2. According to risk factor analysis, reducing the incidence of chronic lung disease and/or apnea, IVH, and nutritional deprivation is a key factor in improving the intellectual outcomes of EP infants.
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Affiliation(s)
- Maya Asami
- Department of Pediatrics, School of Medicine, Iwate Medical University, Morioka, Iwate, Japan
| | - Atsushi Kamei
- Department of Pediatrics, School of Medicine, Iwate Medical University, Morioka, Iwate, Japan
| | - Misato Nakakarumai
- Department of Pediatrics, School of Medicine, Iwate Medical University, Morioka, Iwate, Japan
| | - Satoko Shirasawa
- Department of Pediatrics, School of Medicine, Iwate Medical University, Morioka, Iwate, Japan
| | - Manami Akasaka
- Department of Pediatrics, School of Medicine, Iwate Medical University, Morioka, Iwate, Japan
| | - Nami Araya
- Department of Pediatrics, School of Medicine, Iwate Medical University, Morioka, Iwate, Japan
| | - Sachiko Tanifuji
- Department of Pediatrics, School of Medicine, Iwate Medical University, Morioka, Iwate, Japan
| | - Shoichi Chida
- Department of Pediatrics, School of Medicine, Iwate Medical University, Morioka, Iwate, Japan
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34
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Younge N, Goldstein RF, Bann CM, Hintz SR, Patel RM, Smith PB, Bell EF, Rysavy MA, Duncan AF, Vohr BR, Das A, Goldberg RN, Higgins RD, Cotten CM. Survival and Neurodevelopmental Outcomes among Periviable Infants. N Engl J Med 2017; 376:617-628. [PMID: 28199816 PMCID: PMC5456289 DOI: 10.1056/nejmoa1605566] [Citation(s) in RCA: 371] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Data reported during the past 5 years indicate that rates of survival have increased among infants born at the borderline of viability, but less is known about how increased rates of survival among these infants relate to early childhood neurodevelopmental outcomes. METHODS We compared survival and neurodevelopmental outcomes among infants born at 22 to 24 weeks of gestation, as assessed at 18 to 22 months of corrected age, across three consecutive birth-year epochs (2000-2003 [epoch 1], 2004-2007 [epoch 2], and 2008-2011 [epoch 3]). The infants were born at 11 centers that participated in the National Institute of Child Health and Human Development Neonatal Research Network. The primary outcome measure was a three-level outcome - survival without neurodevelopmental impairment, survival with neurodevelopmental impairment, or death. After accounting for differences in infant characteristics, including birth center, we used multinomial generalized logit models to compare the relative risk of survival without neurodevelopmental impairment, survival with neurodevelopmental impairment, and death. RESULTS Data on the primary outcome were available for 4274 of 4458 infants (96%) born at the 11 centers. The percentage of infants who survived increased from 30% (424 of 1391 infants) in epoch 1 to 36% (487 of 1348 infants) in epoch 3 (P<0.001). The percentage of infants who survived without neurodevelopmental impairment increased from 16% (217 of 1391) in epoch 1 to 20% (276 of 1348) in epoch 3 (P=0.001), whereas the percentage of infants who survived with neurodevelopmental impairment did not change significantly (15% [207 of 1391] in epoch 1 and 16% [211 of 1348] in epoch 3, P=0.29). After adjustment for changes in the baseline characteristics of the infants over time, both the rate of survival with neurodevelopmental impairment (as compared with death) and the rate of survival without neurodevelopmental impairment (as compared with death) increased over time (adjusted relative risks, 1.27 [95% confidence interval {CI}, 1.01 to 1.59] and 1.59 [95% CI, 1.28 to 1.99], respectively). CONCLUSIONS The rate of survival without neurodevelopmental impairment increased between 2000 and 2011 in this large cohort of periviable infants. (Funded by the National Institutes of Health and others; ClinicalTrials.gov numbers, NCT00063063 and NCT00009633 .).
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Affiliation(s)
- Noelle Younge
- From the Department of Pediatrics, Duke University, Durham (N.Y., R.F.G., P.B.S., R.N.G., C.M.C.), and the Statistics and Epidemiology Unit, RTI International, Research Triangle Park (C.M.B., A.D.) - both in North Carolina; the Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA (S.R.H.); the Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (R.M.P.); the Department of Pediatrics, University of Iowa, Iowa City (E.F.B., M.A.R.); the Department of Pediatrics, University of Wisconsin, Madison (M.A.R.); the Department of Pediatrics, University of Texas Medical School at Houston, Houston (A.F.D.); the Department of Pediatrics, Women and Infants' Hospital, Brown University, Providence, RI (B.R.V.); and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (R.D.H.)
| | - Ricki F Goldstein
- From the Department of Pediatrics, Duke University, Durham (N.Y., R.F.G., P.B.S., R.N.G., C.M.C.), and the Statistics and Epidemiology Unit, RTI International, Research Triangle Park (C.M.B., A.D.) - both in North Carolina; the Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA (S.R.H.); the Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (R.M.P.); the Department of Pediatrics, University of Iowa, Iowa City (E.F.B., M.A.R.); the Department of Pediatrics, University of Wisconsin, Madison (M.A.R.); the Department of Pediatrics, University of Texas Medical School at Houston, Houston (A.F.D.); the Department of Pediatrics, Women and Infants' Hospital, Brown University, Providence, RI (B.R.V.); and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (R.D.H.)
| | - Carla M Bann
- From the Department of Pediatrics, Duke University, Durham (N.Y., R.F.G., P.B.S., R.N.G., C.M.C.), and the Statistics and Epidemiology Unit, RTI International, Research Triangle Park (C.M.B., A.D.) - both in North Carolina; the Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA (S.R.H.); the Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (R.M.P.); the Department of Pediatrics, University of Iowa, Iowa City (E.F.B., M.A.R.); the Department of Pediatrics, University of Wisconsin, Madison (M.A.R.); the Department of Pediatrics, University of Texas Medical School at Houston, Houston (A.F.D.); the Department of Pediatrics, Women and Infants' Hospital, Brown University, Providence, RI (B.R.V.); and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (R.D.H.)
| | - Susan R Hintz
- From the Department of Pediatrics, Duke University, Durham (N.Y., R.F.G., P.B.S., R.N.G., C.M.C.), and the Statistics and Epidemiology Unit, RTI International, Research Triangle Park (C.M.B., A.D.) - both in North Carolina; the Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA (S.R.H.); the Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (R.M.P.); the Department of Pediatrics, University of Iowa, Iowa City (E.F.B., M.A.R.); the Department of Pediatrics, University of Wisconsin, Madison (M.A.R.); the Department of Pediatrics, University of Texas Medical School at Houston, Houston (A.F.D.); the Department of Pediatrics, Women and Infants' Hospital, Brown University, Providence, RI (B.R.V.); and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (R.D.H.)
| | - Ravi M Patel
- From the Department of Pediatrics, Duke University, Durham (N.Y., R.F.G., P.B.S., R.N.G., C.M.C.), and the Statistics and Epidemiology Unit, RTI International, Research Triangle Park (C.M.B., A.D.) - both in North Carolina; the Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA (S.R.H.); the Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (R.M.P.); the Department of Pediatrics, University of Iowa, Iowa City (E.F.B., M.A.R.); the Department of Pediatrics, University of Wisconsin, Madison (M.A.R.); the Department of Pediatrics, University of Texas Medical School at Houston, Houston (A.F.D.); the Department of Pediatrics, Women and Infants' Hospital, Brown University, Providence, RI (B.R.V.); and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (R.D.H.)
| | - P Brian Smith
- From the Department of Pediatrics, Duke University, Durham (N.Y., R.F.G., P.B.S., R.N.G., C.M.C.), and the Statistics and Epidemiology Unit, RTI International, Research Triangle Park (C.M.B., A.D.) - both in North Carolina; the Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA (S.R.H.); the Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (R.M.P.); the Department of Pediatrics, University of Iowa, Iowa City (E.F.B., M.A.R.); the Department of Pediatrics, University of Wisconsin, Madison (M.A.R.); the Department of Pediatrics, University of Texas Medical School at Houston, Houston (A.F.D.); the Department of Pediatrics, Women and Infants' Hospital, Brown University, Providence, RI (B.R.V.); and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (R.D.H.)
| | - Edward F Bell
- From the Department of Pediatrics, Duke University, Durham (N.Y., R.F.G., P.B.S., R.N.G., C.M.C.), and the Statistics and Epidemiology Unit, RTI International, Research Triangle Park (C.M.B., A.D.) - both in North Carolina; the Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA (S.R.H.); the Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (R.M.P.); the Department of Pediatrics, University of Iowa, Iowa City (E.F.B., M.A.R.); the Department of Pediatrics, University of Wisconsin, Madison (M.A.R.); the Department of Pediatrics, University of Texas Medical School at Houston, Houston (A.F.D.); the Department of Pediatrics, Women and Infants' Hospital, Brown University, Providence, RI (B.R.V.); and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (R.D.H.)
| | - Matthew A Rysavy
- From the Department of Pediatrics, Duke University, Durham (N.Y., R.F.G., P.B.S., R.N.G., C.M.C.), and the Statistics and Epidemiology Unit, RTI International, Research Triangle Park (C.M.B., A.D.) - both in North Carolina; the Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA (S.R.H.); the Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (R.M.P.); the Department of Pediatrics, University of Iowa, Iowa City (E.F.B., M.A.R.); the Department of Pediatrics, University of Wisconsin, Madison (M.A.R.); the Department of Pediatrics, University of Texas Medical School at Houston, Houston (A.F.D.); the Department of Pediatrics, Women and Infants' Hospital, Brown University, Providence, RI (B.R.V.); and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (R.D.H.)
| | - Andrea F Duncan
- From the Department of Pediatrics, Duke University, Durham (N.Y., R.F.G., P.B.S., R.N.G., C.M.C.), and the Statistics and Epidemiology Unit, RTI International, Research Triangle Park (C.M.B., A.D.) - both in North Carolina; the Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA (S.R.H.); the Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (R.M.P.); the Department of Pediatrics, University of Iowa, Iowa City (E.F.B., M.A.R.); the Department of Pediatrics, University of Wisconsin, Madison (M.A.R.); the Department of Pediatrics, University of Texas Medical School at Houston, Houston (A.F.D.); the Department of Pediatrics, Women and Infants' Hospital, Brown University, Providence, RI (B.R.V.); and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (R.D.H.)
| | - Betty R Vohr
- From the Department of Pediatrics, Duke University, Durham (N.Y., R.F.G., P.B.S., R.N.G., C.M.C.), and the Statistics and Epidemiology Unit, RTI International, Research Triangle Park (C.M.B., A.D.) - both in North Carolina; the Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA (S.R.H.); the Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (R.M.P.); the Department of Pediatrics, University of Iowa, Iowa City (E.F.B., M.A.R.); the Department of Pediatrics, University of Wisconsin, Madison (M.A.R.); the Department of Pediatrics, University of Texas Medical School at Houston, Houston (A.F.D.); the Department of Pediatrics, Women and Infants' Hospital, Brown University, Providence, RI (B.R.V.); and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (R.D.H.)
| | - Abhik Das
- From the Department of Pediatrics, Duke University, Durham (N.Y., R.F.G., P.B.S., R.N.G., C.M.C.), and the Statistics and Epidemiology Unit, RTI International, Research Triangle Park (C.M.B., A.D.) - both in North Carolina; the Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA (S.R.H.); the Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (R.M.P.); the Department of Pediatrics, University of Iowa, Iowa City (E.F.B., M.A.R.); the Department of Pediatrics, University of Wisconsin, Madison (M.A.R.); the Department of Pediatrics, University of Texas Medical School at Houston, Houston (A.F.D.); the Department of Pediatrics, Women and Infants' Hospital, Brown University, Providence, RI (B.R.V.); and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (R.D.H.)
| | - Ronald N Goldberg
- From the Department of Pediatrics, Duke University, Durham (N.Y., R.F.G., P.B.S., R.N.G., C.M.C.), and the Statistics and Epidemiology Unit, RTI International, Research Triangle Park (C.M.B., A.D.) - both in North Carolina; the Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA (S.R.H.); the Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (R.M.P.); the Department of Pediatrics, University of Iowa, Iowa City (E.F.B., M.A.R.); the Department of Pediatrics, University of Wisconsin, Madison (M.A.R.); the Department of Pediatrics, University of Texas Medical School at Houston, Houston (A.F.D.); the Department of Pediatrics, Women and Infants' Hospital, Brown University, Providence, RI (B.R.V.); and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (R.D.H.)
| | - Rosemary D Higgins
- From the Department of Pediatrics, Duke University, Durham (N.Y., R.F.G., P.B.S., R.N.G., C.M.C.), and the Statistics and Epidemiology Unit, RTI International, Research Triangle Park (C.M.B., A.D.) - both in North Carolina; the Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA (S.R.H.); the Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (R.M.P.); the Department of Pediatrics, University of Iowa, Iowa City (E.F.B., M.A.R.); the Department of Pediatrics, University of Wisconsin, Madison (M.A.R.); the Department of Pediatrics, University of Texas Medical School at Houston, Houston (A.F.D.); the Department of Pediatrics, Women and Infants' Hospital, Brown University, Providence, RI (B.R.V.); and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (R.D.H.)
| | - C Michael Cotten
- From the Department of Pediatrics, Duke University, Durham (N.Y., R.F.G., P.B.S., R.N.G., C.M.C.), and the Statistics and Epidemiology Unit, RTI International, Research Triangle Park (C.M.B., A.D.) - both in North Carolina; the Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA (S.R.H.); the Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (R.M.P.); the Department of Pediatrics, University of Iowa, Iowa City (E.F.B., M.A.R.); the Department of Pediatrics, University of Wisconsin, Madison (M.A.R.); the Department of Pediatrics, University of Texas Medical School at Houston, Houston (A.F.D.); the Department of Pediatrics, Women and Infants' Hospital, Brown University, Providence, RI (B.R.V.); and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (R.D.H.)
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Abstract
Infants born at extreme preterm gestation are at risk for both death and disability. Although rates of survival have improved for this population, and some evidence suggests a trend toward decreased neuromotor impairment over the past decades, a significant improvement in overall early neurodevelopmental outcome has not yet been realized. This review will examine the rates and types of neurodevelopmental impairment seen after extremely preterm birth, including neurosensory, motor, cognitive, and behavioral outcomes. We focus on early outcomes in the first 18-36 months of life, as the majority of large neonatal studies examining neurodevelopmental outcomes stop at this age. However, this early age is clearly just a first glimpse into lifetime outcomes; the neurodevelopmental effects of extreme prematurity may last through school age, adolescence, and beyond. Importantly, prematurity appears to be an independent risk factor for adverse development, but this population demonstrates considerable variability in the types and severity of impairments. Understanding both the nature and prevalence of neurodevelopmental impairment among extremely preterm infants is important because it can lead to targeted interventions that in turn may lead to improved outcomes.
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Affiliation(s)
- Elizabeth E Rogers
- Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, 550 4th St, 5th Floor, Box 0743, San Francisco, CA 94143.
| | - Susan R Hintz
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Palo Alto, CA
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Kuban KCK, Joseph RM, O’Shea TM, Allred EN, Heeren T, Douglass L, Stafstrom CE, Jara H, Frazier JA, Hirtz D, Leviton A. Girls and Boys Born before 28 Weeks Gestation: Risks of Cognitive, Behavioral, and Neurologic Outcomes at Age 10 Years. J Pediatr 2016; 173:69-75.e1. [PMID: 27004675 PMCID: PMC4884461 DOI: 10.1016/j.jpeds.2016.02.048] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/29/2016] [Accepted: 02/18/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To compare the prevalence of cognitive, neurologic, and behavioral outcomes at 10 years of age in 428 girls and 446 boys who were born extremely preterm. STUDY DESIGN A total of 889 of 966 eligible children previously enrolled in the multicenter Extremely Low Gestational Age Newborns Study from 2002-2004 were evaluated at 10 years of age. Children underwent a neuropsychological battery and testing for autism spectrum disorder (ASD), and parents reported on their child's behavior, development, and seizures. RESULTS Of the children, 28% of boys and 21% of girls exhibited moderate to severe impairment on summary measures of cognitive abilities. Boys had a higher prevalence of impairment than girls in nearly all measures of cognition, were more than twice as likely to have microcephaly (15% in boys, 8% in girls), and require more often assistive devices to ambulate (6% in boys, 4% in girls). In contrast, boys and girls had comparable risk for a history of seizure (identified in 10% of the cohort) or epilepsy (identified in 7% of the cohort). The boy-to-girl ratio of ASD (9% in boys, 5% in girls) was lower than expected compared with the overall US autism population. CONCLUSIONS In this contemporary cohort of children born extremely premature and evaluated at school age, boys had higher prevalence of cognitive, neurologic, and behavioral deficits than girls. The ratio of boys to girls among those with ASD deserves further study as does the perinatal environmental-genetic interactions that might contribute to male preponderance of deficits in this high-risk sample.
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Affiliation(s)
- Karl C. K. Kuban
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | - Robert M. Joseph
- Department of Anatomy and Neurobiology, Boston University, Boston, MA
| | - Thomas M. O’Shea
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina, Chapel Hill, NC
| | - Elizabeth N. Allred
- Department of Neurology, Harvard Medical School, Boston, MA, USA,Department of Neurology, Neuroepidemiology Unit, Boston Children’s Hospital, Boston, MA, USA
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Laurie Douglass
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | - Carl E. Stafstrom
- Division of Pediatric Neurology, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD
| | - Hernan Jara
- Department of Radiology, Boston Medical Center, Boston University, Boston, USA
| | - Jean A. Frazier
- Department of Psychiatry, UMASS Medical School/ University of Massachusetts Memorial Health Care, Worcester, MA, USA
| | - Deborah Hirtz
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Alan Leviton
- Department of Neurology, Harvard Medical School, Boston, MA, USA,Department of Neurology, Neuroepidemiology Unit, Boston Children’s Hospital, Boston, MA, USA
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Ethawi YH, Abou Mehrem A, Minski J, Ruth CA, Davis PG. High frequency jet ventilation versus high frequency oscillatory ventilation for pulmonary dysfunction in preterm infants. Cochrane Database Syst Rev 2016; 2016:CD010548. [PMID: 27149997 PMCID: PMC6769183 DOI: 10.1002/14651858.cd010548.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Respiratory distress syndrome (RDS) is considered one of the major contributors to severe pulmonary dysfunction and consequent death in preterm infants. Despite widespread improvements in care, including increased utilization of antenatal steroids, use of surfactant replacement therapy, and advances in conventional mechanical ventilation (CMV), chronic lung disease (CLD) occurs in 42% of surviving preterm infants born at less than 28 weeks gestational age (GA). High frequency ventilation (HFV) aims to optimize lung expansion while minimizing tidal volume (Vt) to decrease lung injury. Two methods of HFV - high frequency oscillatory ventilation (HFOV) and high frequency jet ventilation (HFJV) - are widely used, but neither has demonstrated clear superiority in elective or rescue mode. OBJECTIVES To compare the benefits and side effects of HFJV versus HFOV for mortality and morbidity in preterm infants born at less than 37 weeks GA with pulmonary dysfunction in both elective and rescue modes. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 11), MEDLINE via PubMed (1966 to November 30, 2015), EMBASE (1980 to November 30, 2015), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to November 30, 2015). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. We imposed no date, language, or publication restrictions. SELECTION CRITERIA We planned to include randomized, cluster-randomized, and quasi-randomized controlled trials if study authors stated explicitly that groups compared in the trial were established by a random or systematic method of allocation. We planned to exclude cross-over studies, as they would not allow assessment of the outcomes of interest. DATA COLLECTION AND ANALYSIS We used the standard methods of the Neonatal Cochrane Review Group, including independent trial assessment and data extraction. We intended to analyze the data by using risk ratios (RRs) and risk differences (RDs) and 1/RD. We planned to calculate the number needed to treat for an additional beneficial outcome (NNTB) or the number needed to treat for an additional harmful outcome (NNTH). MAIN RESULTS We found no studies that met our inclusion criteria. AUTHORS' CONCLUSIONS We found no evidence to support the superiority of HFJV or HFOV as elective or rescue therapy. Until such evidence is available, comparison of potential side effects or presumed benefits of either mode is not feasible.
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Affiliation(s)
- Yahya H Ethawi
- Health Sciences CentreWinnipeg Regional Health Authority735 Notre Dame AvenueWS 012 Women's HospitalWinnipegMBCanadaR3E 0L8
| | - Ayman Abou Mehrem
- University of CalgaryDepartment of Pediatrics, Section of NeonatologyFoothills Medical Centre, 1403 29th Street NWRoom 780CalgaryABCanadaT2N 2T9
| | - John Minski
- Children's Hospital, Health Sciences CentreRespiratory Department735 Notre Dame AvenueWS 012 Women's HospitalWinnipegMBCanadaR3E 0L8
| | - Chelsea A Ruth
- University of ManitobaDepartment of Pediatrics and Child Health820 Sherbrook StWinnipegMBCanadaR3A 1R9
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Younge N, Smith PB, Gustafson KE, Malcolm W, Ashley P, Cotten CM, Goldberg RN, Goldstein RF. Improved survival and neurodevelopmental outcomes among extremely premature infants born near the limit of viability. Early Hum Dev 2016; 95:5-8. [PMID: 26900775 PMCID: PMC4808394 DOI: 10.1016/j.earlhumdev.2016.01.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 01/07/2016] [Accepted: 01/12/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Infants born near the limit of viability are at high risk for death or adverse neurodevelopmental outcomes. It is unclear whether these outcomes have improved over the past 15 years. AIM To determine if death and neurodevelopmental impairment have declined over the past 15 years in infants born at 22 to 24 weeks' gestation. STUDY DESIGN Retrospective cohort study. SUBJECTS We identified infants born at 22 to 24 weeks' gestation in our center in two epochs: 1998-2004 (Epoch 1) and 2005-2011 (Epoch 2). OUTCOME MEASURES The primary outcome, death or neurodevelopmental impairment, was evaluated at 17-25 months' corrected gestational age with neurologic exams and Bayley Scales of Infant Development. Perinatal characteristics, major morbidities, and outcomes were compared between epochs. RESULTS Birth weight and gestational age were similar between 170 infants in Epoch 1 and 187 infants in Epoch 2. Mortality was significantly lower in Epoch 2, 55% vs. 42% (p=0.02). Among surviving infants, late-onset sepsis (p<0.01), bronchopulmonary dysplasia (p<0.01), and surgical necrotizing enterocolitis (p=0.04) were less common in Epoch 2. Neurodevelopmental impairment among surviving infants declined from 68% in Epoch 1 to 47% in Epoch 2, p=0.02. Odds of death or NDI were significantly lower in Epoch 2 vs. Epoch 1, OR=0.31 (95% confidence interval; 0.16, 0.58). CONCLUSION Risk of death or neurodevelopmental impairment decreased over time in infants born at 22 to 24 weeks' gestation.
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Affiliation(s)
- Noelle Younge
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, the Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC, USA.
| | - P Brian Smith
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, the Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC, USA
| | - Kathryn E Gustafson
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, the Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC, USA
| | - William Malcolm
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, the Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC, USA
| | - Patricia Ashley
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, the Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC, USA
| | - C Michael Cotten
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, the Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC, USA
| | - Ronald N Goldberg
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, the Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC, USA
| | - Ricki F Goldstein
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, the Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC, USA
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Choi JY, Rha DW, Park ES. The Effects of the Severity of Periventricular Leukomalacia on the Neuropsychological Outcomes of Preterm Children. J Child Neurol 2016; 31:603-12. [PMID: 26385973 DOI: 10.1177/0883073815604229] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/27/2015] [Indexed: 11/16/2022]
Abstract
This study investigates the developmental outcomes of preterm children according to severity of periventricular leukomalacia. One hundred preterm children with periventricular leukomalacia evident on brain magnetic resonance imaging and who had undergone neuropsychologic evaluation were selected. Intellectual disability was noted in 27.8% of the children with mild periventricular leukomalacia, 53.2% with moderate periventricular leukomalacia, and 77.1% with severe periventricular leukomalacia. The rates of major neurodevelopmental impairments such as cerebral palsy or intellectual disability were related to the severity of periventricular leukomalacia but not to gestational age or epilepsy. There were significant differences in the intelligence quotient (IQ) and social maturity quotient between 3 groups of periventricular leukomalacia. The performance IQ was significantly lower than the verbal IQ. Behavioral problems were noted in about one-third of the children but the rate was not related with the severity of periventricular leukomalacia. Our study revealed the significant associations between severity of periventricular leukomalacia and cognitive and social adaptive functions in the preterm children.
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Affiliation(s)
- Ja Young Choi
- Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong-wook Rha
- Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Sook Park
- Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Assad M, Elliott MJ, Abraham JH. Decreased cost and improved feeding tolerance in VLBW infants fed an exclusive human milk diet. J Perinatol 2016; 36:216-20. [PMID: 26562370 DOI: 10.1038/jp.2015.168] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 10/08/2015] [Accepted: 10/08/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Human milk is the best form of nutrition for preterm infants and has been associated with a lower incidence of necrotizing enterocolitis (NEC). Infants that develop NEC have a higher incidence of feeding intolerance and longer hospitalizations. The combination of a donor milk bank and donor milk-derived fortifier has changed feeding practices in neonatal intensive care units (NICU). The purpose of this study is to assess the benefits and cost of an exclusive human milk (EHM) diet in very low birth weight (VLBW) infants in a community level III NICU. STUDY DESIGN This is a retrospective study including preterm infants ⩽28 weeks and/or VLBW (⩽1500 g) who were enrolled from March 2009 until March 2014. Infants were grouped as follows: group H (entirely human milk based, born March 2012 to 2014), group B (bovine-based fortifier and maternal milk, born March 2009 to 2012), group M (mixed combination of maternal milk, bovine-based fortifier and formula, born March 2009 to 2012) and group F (formula fed infants, born March 2009 to 2012). Baseline characteristics among the four groups were similar. RESULT The study included 293 infants between gestational ages 23 to 34 weeks and birth weights between 490 and 1700 g. Feeding intolerance occurred less often (P<0.0001), number of days to full feeds was lower (P<0.001), incidence of NEC was lower (P<0.011), and total hospitalization costs were lower by up to $106,968 per infant (P<0.004) in those fed an EHM diet compared with the other groups. Average weight gain per day was similar among the four groups (18.5 to 20.6 g per day). CONCLUSIONS Implementing an EHM diet in our VLBW infants has led to a significant decrease in the incidence of NEC. Other benefits of this diet include: decreased feeding intolerance, shorter time to full feeds, shorter length of stay, and lower hospital and physician charges for extremely premature and VLBW infants.
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Affiliation(s)
- M Assad
- Division of Neonatology, Department of Pediatrics, Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD, USA
| | - M J Elliott
- Division of Neonatology, Department of Pediatrics, Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD, USA.,Pediatrix Medical Group of Maryland, The Herman & Walter Samuelson Children's Hospital at Sinai, Baltimore, MD, USA
| | - J H Abraham
- Division of Neonatology, Department of Pediatrics, Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD, USA
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Cassir N, Simeoni U, La Scola B. Gut microbiota and the pathogenesis of necrotizing enterocolitis in preterm neonates. Future Microbiol 2016; 11:273-92. [PMID: 26855351 DOI: 10.2217/fmb.15.136] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Necrotizing enterocolitis (NEC) remains a devastating intestinal disease in preterm neonates. In this population, disruption of the gut microbiota development, mainly due to organ immaturity, antibiotic use and hospital microbial environment, plays a key role in the pathogenesis of NEC. This gut dysbiosis has been associated with opportunistic pathogens overgrowth, expression of virulence factors, altered metabolic functions and inflammatory dysregulated responses. In this review, we provide an updated summary of the host and gut microbiota interactions during the formative early life. We also explore the key determinants of gut dysbiosis in preterm neonates with NEC. Finally, we discuss the promising role of bacteriotherapy in the management of NEC, the aim being to shape or restore the beneficial gut bacterial communities.
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Affiliation(s)
- Nadim Cassir
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, INSERM U1095, Facultés de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Umberto Simeoni
- Service de Pédiatrie, Centre Hospitalier Universitaire Vaudois, Lausanne, Suisse, Switzerland
| | - Bernard La Scola
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, INSERM U1095, Facultés de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
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Gopagondanahalli KR, Li J, Fahey MC, Hunt RW, Jenkin G, Miller SL, Malhotra A. Preterm Hypoxic-Ischemic Encephalopathy. Front Pediatr 2016; 4:114. [PMID: 27812521 PMCID: PMC5071348 DOI: 10.3389/fped.2016.00114] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/05/2016] [Indexed: 11/18/2022] Open
Abstract
Hypoxic-ischemic encephalopathy (HIE) is a recognizable and defined clinical syndrome in term infants that results from a severe or prolonged hypoxic-ischemic episode before or during birth. However, in the preterm infant, defining hypoxic-ischemic injury (HII), its clinical course, monitoring, and outcomes remains complex. Few studies examine preterm HIE, and these are heterogeneous, with variable inclusion criteria and outcomes reported. We examine the available evidence that implies that the incidence of hypoxic-ischemic insult in preterm infants is probably higher than recognized and follows a more complex clinical course, with higher rates of adverse neurological outcomes, compared to term infants. This review aims to elucidate the causes and consequences of preterm hypoxia-ischemia, the subsequent clinical encephalopathy syndrome, diagnostic tools, and outcomes. Finally, we suggest a uniform definition for preterm HIE that may help in identifying infants most at risk of adverse outcomes and amenable to neuroprotective therapies.
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Affiliation(s)
| | - Jingang Li
- The Ritchie Centre, Hudson Institute of Medical Research , Melbourne, VIC , Australia
| | - Michael C Fahey
- Monash Children's Hospital, Melbourne, VIC, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia; Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Rod W Hunt
- The Royal Children's Hospital, Melbourne, VIC, Australia; Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Graham Jenkin
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Suzanne L Miller
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Atul Malhotra
- Monash Children's Hospital, Melbourne, VIC, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia; Department of Paediatrics, Monash University, Melbourne, VIC, Australia
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43
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Zhou J, Shukla VV, John D, Chen C. Human Milk Feeding as a Protective Factor for Retinopathy of Prematurity: A Meta-analysis. Pediatrics 2015; 136:e1576-86. [PMID: 26574589 DOI: 10.1542/peds.2015-2372] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2015] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Studies have suggested that human milk feeding decreases the incidence of retinopathy of prematurity (ROP); however, conflicting results have been reported. OBJECTIVE The aim of this meta-analysis was to pool currently available data on incidence of ROP in infants fed human milk versus formula. DATA SOURCES Medline, PubMed, and EBSCO were searched for articles published through February 2015. STUDY SELECTION Longitudinal studies comparing the incidence of ROP in infants who were fed human milk and formula were selected. Studies involving donor milk were not included. DATA EXTRACTION Two independent reviewers conducted the searches and extracted data. Meta-analysis used odds ratios (ORs), and subgroup analyses were performed. RESULTS Five studies with 2208 preterm infants were included. Searches including various proportions of human milk versus formula, any-stage ROP, and severe ROP were defined to pool data for analyses. For any-stage ROP, the ORs (95% confidence intervals [CIs]) were as follows: exclusive human milk versus any formula, 0.29 (0.12 to 0.72); mainly human milk versus mainly formula, 0.51 (0.26 to 1.03); any human milk versus exclusive formula, 0.54 (0.15 to 1.96); and exclusive human milk versus exclusive formula, 0.25 (0.13 to 0.49). For severe ROP, they were 0.11 (0.04 to 0.30), 0.16 (0.06 to 0.43), 0.42 (0.08 to 2.18), and 0.10 (0.04 to 0.29), respectively. LIMITATIONS Prospective randomized studies being impossible because of ethical issues, we chose observational studies for analysis. A few studies involving subgroup analyses presented high heterogeneity. CONCLUSIONS Based on current limited evidence, in very preterm newborns, human milk feeding potentially plays a protective role in preventing any-stage ROP and severe ROP.
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Affiliation(s)
- Jianguo Zhou
- Children's Hospital of Fudan University, Shanghai, China
| | | | - Denny John
- People's Open Access Education Initiative, Manchester, United Kingdom
| | - Chao Chen
- Children's Hospital of Fudan University, Shanghai, China;
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44
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Abstract
Worldwide, neonatal networks have been formed to address both the research and quality improvement agenda of neonatal-perinatal medicine. Neonatal research networks have led the way in conducting many of the most important clinical trials of the last 25 years, including studies of cooling for hypoxic-ischemic encephalopathy, delivery room management with less invasive support, and oxygen saturation targeting. As we move into the future, increasing numbers of these networks are tackling quality improvement initiatives as a priority of their collaboration. Neonatal quality improvement networks have been in the forefront of the quality movement in medicine and, in the 21st century, have contributed to many of the reported improvements in care. In the coming years, building and maintaining this community of care is critical to the success of neonatal-perinatal medicine.
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Affiliation(s)
- Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA; California Perinatal Quality Care Collaborative, Palo Alto, CA, USA.
| | - Roger F Soll
- Vermont Oxford Network, Burlington, VT, USA; Department of Pediatrics, University of Vermont College of Medicine, Burlington, VT, USA
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Winstanley A, Lamb ME, Ellis-Davies K, Rentfrow PJ. The subjective well-being of adults born preterm. JOURNAL OF RESEARCH IN PERSONALITY 2015. [DOI: 10.1016/j.jrp.2015.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Dempsey AG, Abrahamson CW, Keller-Margulis MA. Developmental Screening Among Children Born Preterm in a High-Risk Follow-Up Clinic. J Pediatr Psychol 2015; 41:573-81. [PMID: 26542281 DOI: 10.1093/jpepsy/jsv101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 10/02/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The psychometric properties of two formats of developmental screening tools that may be used in follow-up clinics providing primary care to children born preterm are presented. METHODS 28 children born extremely preterm (<27 weeks) attending a high-risk clinic at the time of their 18-24 month visit were administered the Child Development Review, Brigance Early Head Start Screen II, and Bayley Scales of Infant and Toddler Development-Third Edition. RESULTS Both screeners identified the majority of the sample as at-risk. The Brigance Screen II more accurately identified children at-risk compared with the Child Developmental Review (sensitivity: 1.00 and 0.44; specificity: 0.60 and 0.80; positive predictive value: 79% and 80%; negative predictive value: 100% and 44%, respectively). CONCLUSIONS Screening assessments using direct skills assessment may be an efficient and effective method of identifying children with developmental delays, particularly high-frequency but lower severity difficulties, in high-risk follow-up care settings.
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Picciolini O, Squarza C, Fontana C, Giannì ML, Cortinovis I, Gangi S, Gardon L, Presezzi G, Fumagalli M, Mosca F. Neurodevelopmental outcome of extremely low birth weight infants at 24 months corrected age: a comparison between Griffiths and Bayley Scales. BMC Pediatr 2015; 15:139. [PMID: 26419231 PMCID: PMC4589038 DOI: 10.1186/s12887-015-0457-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/15/2015] [Indexed: 11/10/2022] Open
Abstract
Background The availability of accurate assessment tools for the early detection of infants at risk for adverse neurodevelopmental outcomes is a major issue. The purpose of this study is to compare the outcomes of the Bayley Scales (Bayley-II vs Bayley-III) in a cohort of extremely low birth weight infants at 24 months corrected age, to define which edition shows the highest agreement with the Griffiths Mental Development Scales Revised. Methods We performed a single-centre cohort study. We prospectively enrolled infants with a birth weight of 401–1000 g and/or gestational age < 28 weeks. Exclusion criteria were the presence of neurosensory disabilities and/or genetic abnormalities. Infants underwent neurodevelopmental evaluation at 24 months corrected age using the Griffiths and either the Bayley-II (birth years 2003–2006) or the Bayley-III (birth years 2007–2010). Results A total of 194 infants were enrolled. Concordance was excellent between the Griffiths and the Bayley-III composite scores for both cognitive language and motor abilities (weighted K = 0.80 and 0.81, respectively) but poorer for the Bayley-II (weighted K = 0.63 and 0.50, respectively). The Youden’s Index revealed higher values for the Bayley-III than for the Bayley-II (75.9 vs 69.6 %). Compared with the Griffiths, the Bayley-III found 3 % fewer infants as being severely impaired in cognitive-language abilities and 7.8 % fewer infants as being mildly impaired in motor skills while the Bayley-II showed, compared with the Griffiths, higher rates of severely impaired children both for cognitive-language and motor abilities (14.1 and 15.3 % more infants respectively). Discussion Our study suggests that the Bayley-III, although having a higher agreement with the Griffiths compared to the Bayley-II, slightly tends to underestimate neurodevelopmental impairment compared with the Griffiths, whereas the Bayley-II tends to overestimate it. Conclusions On the basis of these findings, we recommend the use of multiple measures to assess neurodevelopmental outcomes of extremely low birth weight infants at 24 months.
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Affiliation(s)
- Odoardo Picciolini
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Della Commenda 12, Milan, 20122, Italy.
| | - Chiara Squarza
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Della Commenda 12, Milan, 20122, Italy.
| | - Camilla Fontana
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Della Commenda 12, Milan, 20122, Italy.
| | - Maria Lorella Giannì
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Della Commenda 12, Milan, 20122, Italy.
| | - Ivan Cortinovis
- Department of Clinical Sciences and Community Health-Laboratory of Medical Statistics, Biometry and Epidemiology, Università degli Studi di Milano, Via Della Commenda 12, Milan, 20122, Italy.
| | - Silvana Gangi
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Della Commenda 12, Milan, 20122, Italy.
| | - Laura Gardon
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Della Commenda 12, Milan, 20122, Italy.
| | - Gisella Presezzi
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Della Commenda 12, Milan, 20122, Italy.
| | - Monica Fumagalli
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Della Commenda 12, Milan, 20122, Italy.
| | - Fabio Mosca
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Della Commenda 12, Milan, 20122, Italy.
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Adams-Chapman I, Bann C, Carter SL, Stoll BJ. Language outcomes among ELBW infants in early childhood. Early Hum Dev 2015; 91:373-9. [PMID: 25955535 PMCID: PMC4442021 DOI: 10.1016/j.earlhumdev.2015.03.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 01/30/2015] [Accepted: 03/08/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Limited data are available evaluating language outcomes of preterm infants in early childhood. Furthermore, the relationship between language outcomes, medical morbidities and developmental trajectory in early infancy is unclear. AIMS The goal of this study was to evaluate language outcomes among extremely low birth weight (ELBW) infants at 30months adjusted age (AA). STUDY DESIGN The Bayley Scales of Infant Development II and the Peabody Picture Vocabulary Test or Expressive One Word Picture Vocabulary Test/Receptive One Word Picture Vocabulary Test were administered at 30months AA to a prospective cohort of ELBW infants who participated in the NICHD Neonatal Network Glutamine Trial and Neurodevelopmental Follow-Up Study. A standardized history and physical examination and query regarding feeding behaviors were performed at 18months AA and 30months AA. RESULTS Of the 467 infants evaluated, 55% had receptive language delay at 30months with 23% having severe delays. Fewer (26%) had expressive language delays, with 16% of those being severe delays. Non-English speaking infants had poorer performance on all language measures compared to English-speaking infants. Forty-seven percent of the cohort required assistance with feeds at 18months. These children were more likely to have language delay at the 30month assessment compared to infants who could feed themselves. CONCLUSIONS ELBW infants are at risk of language delay in early childhood. Additional research is needed to further explore the relationship between early predictors of language delay and the use of monolingual language assessments in non-English speaking patients with a history of prematurity.
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Affiliation(s)
- Ira Adams-Chapman
- Emory University School of Medicine, Department of Pediatrics, 2015 Uppergate Drive, Atlanta, GA 30303, United States.
| | - Carla Bann
- Research Triangle Institute, Research Triangle Park, NC, United States.
| | - Sheena L. Carter
- Emory University School of Medicine, Atlanta, Georgia, Department of Pediatrics 2015 Uppergate Drive Atlanta, GA 30303
| | - Barbara J. Stoll
- Emory University School of Medicine, Atlanta, Georgia, Department of Pediatrics 2015 Uppergate Drive Atlanta, GA 30303
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Glass HC, Costarino AT, Stayer SA, Brett CM, Cladis F, Davis PJ. Outcomes for extremely premature infants. Anesth Analg 2015; 120:1337-51. [PMID: 25988638 PMCID: PMC4438860 DOI: 10.1213/ane.0000000000000705] [Citation(s) in RCA: 434] [Impact Index Per Article: 48.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Premature birth is a significant cause of infant and child morbidity and mortality. In the United States, the premature birth rate, which had steadily increased during the 1990s and early 2000s, has decreased annually for 7 years and is now approximately 11.39%. Human viability, defined as gestational age at which the chance of survival is 50%, is currently approximately 23 to 24 weeks in developed countries. Infant girls, on average, have better outcomes than infant boys. A relatively uncomplicated course in the intensive care nursery for an extremely premature infant results in a discharge date close to the prenatal estimated date of confinement. Despite technological advances and efforts of child health experts during the last generation, the extremely premature infant (less than 28 weeks gestation) and extremely low birth weight infant (<1000 g) remain at high risk for death and disability with 30% to 50% mortality and, in survivors, at least 20% to 50% risk of morbidity. The introduction of continuous positive airway pressure, mechanical ventilation, and exogenous surfactant increased survival and spurred the development of neonatal intensive care in the 1970s through the early 1990s. Routine administration of antenatal steroids during premature labor improved neonatal mortality and morbidity in the late 1990s. The recognition that chronic postnatal administration of steroids to infants should be avoided may have improved outcomes in the early 2000s. Evidence from recent trials attempting to define the appropriate target for oxygen saturation in preterm infants suggests arterial oxygen saturation between 91% and 95% (compared with 85%-89%) avoids excess mortality; however, final analyses of data from these trials have not been published, so definitive recommendations are still pending. The development of neonatal neurocritical intensive care units may improve neurocognitive outcomes in this high-risk group. Long-term follow-up to detect and address developmental, learning, behavioral, and social problems is critical for children born at these early gestational ages.The striking similarities in response to extreme prematurity in the lung and brain imply that agents and techniques that benefit one organ are likely to also benefit the other. Finally, because therapy and supportive care continue to change, the outcomes of extremely low birth weight infants are ever evolving. Efforts to minimize injury, preserve growth, and identify interventions focused on antioxidant and anti-inflammatory pathways are now being evaluated. Thus, treating and preventing long-term deficits must be developed in the context of a "moving target."
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Affiliation(s)
- Hannah C Glass
- From the *Department of Neurology and Pediatrics, UCSF Benioff Children's Hospital, San Francisco, California; †Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; ‡Department of Pediatric Anesthesiology, The Alfred I. duPont Hospital for Children, Wilmington, Delaware; §Baylor College of Medicine, Texas Children's Hospital, Houston, Texas; ∥Department of Anesthesiology and Perioperative Care, University of California, San Francisco, San Francisco, California; and ¶Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Handley SC, Sun Y, Wyckoff MH, Lee HC. Outcomes of extremely preterm infants after delivery room cardiopulmonary resuscitation in a population-based cohort. J Perinatol 2015; 35:379-83. [PMID: 25521563 PMCID: PMC4414658 DOI: 10.1038/jp.2014.222] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 10/08/2014] [Accepted: 11/03/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe the relationship of delivery room cardiopulmonary resuscitation (DR-CPR) to short-term outcomes of extremely preterm infants. STUDY DESIGN This was a cohort study of 22 to 27+6/7 weeks gestational age (GA) infants during 2005 to 2011. DR-CPR was defined as chest compressions and/or epinephrine administration. Multivariable logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs) associated with DR-CPR; analysis was stratified by GA. RESULT Of the 13 758 infants, 856 (6.2%) received DR-CPR. Infants 22 to 23+6/7 weeks receiving DR-CPR had similar outcomes to non-recipients. Infants 24 to 25+6/7 weeks receiving DR-CPR had more severe intraventricular hemorrhage (OR 1.36, 95% CI 1.07, 1.72). Infants 26 to 27+6/7 weeks receiving DR-CPR were more likely to die (OR 1.81, 95% CI 1.30, 2.51) and have intraventricular hemorrhage (OR 2.10, 95% CI 1.56, 2.82). Adjusted hospital DR-CPR rates varied widely (median 5.7%). CONCLUSION Premature infants receiving DR-CPR had worse outcomes. Mortality and morbidity varied by GA.
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Affiliation(s)
- S C Handley
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Y Sun
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - M H Wyckoff
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - H C Lee
- Department of Pediatrics, Stanford University, California Perinatal Quality Care Collaborative, Stanford, CA, USA
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