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Yanagisawa T, Nakamura T, Kokubo M. Prognosis of 22- and 23-Gestational-Week-Old Infants at Our Facility: A Retrospective Cohort Study. Am J Perinatol 2024; 41:660-668. [PMID: 35193151 DOI: 10.1055/a-1779-4032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This study aimed to compare inborn infants aged 22 and 23 gestational weeks at our hospital to assess for differences in survival and long-term prognosis. STUDY DESIGN We retrospectively analyzed 22- and 23-gestational-weeks-old infants born in our hospital between January 2011 and December 2018. The prognosis of inborn infants in Japan was also calculated using the Neonatal Research Network of Japan (NRNJ) data during the same period. RESULTS The survival rates at our institution's neonatal intensive care unit discharge, including stillbirth, were 72 and 89% at 22 and 23 gestational weeks, respectively. The mortality rate and neurodevelopmental impairment (NDI) rate at 3 years of age, including stillbirth, were 58 and 32% at 22 and 23 weeks, respectively. Cerebral palsy, mental developmental retardation, visual impairment, and hearing impairment defined NDI. The prognosis at our hospital was better than the average calculated using NRNJ data. Survival rates varied among facilities, and some facilities had survival rates similar to that of our hospital. CONCLUSION The prognosis of 22-gestational-week-old inborn infants was inferior to that of 23 gestational weeks in our institution but was better than previously reported. If aggressive treatment is provided, survival without sequelae can be fully expected even for 22-gestational-week-old infants. KEY POINTS · We examined babies of gestation ages 22 and 23 weeks.. · We examined the survival and neurological prognoses.. · We compared our facility with that in entire Japan..
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Affiliation(s)
| | - Tomohiko Nakamura
- Division of Neonatology, Nagano Children's Hospital, Azumino, Nagano, Japan
- Division of Neonatology, Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Masayo Kokubo
- Division of Neonatology, Nagano Children's Hospital, Azumino, Nagano, Japan
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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Vidaeff AC, Kaempf JW. The Ethics and Practice of Periviability Care. CHILDREN (BASEL, SWITZERLAND) 2024; 11:386. [PMID: 38671603 PMCID: PMC11049503 DOI: 10.3390/children11040386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024]
Abstract
Since the 1960s, the gestational age at which premature infants typically survive has decreased by approximately one week per decade [...].
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Affiliation(s)
- Alex C. Vidaeff
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA
- Texas Children’s Hospital Pavilion for Women, 6651 Main Street, Suite F1020, Houston, TX 77030, USA
| | - Joseph W. Kaempf
- Women & Children’s Institute, Providence Health System Oregon, Portland, OR 97232, USA;
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Zhou HP, Hashimoto Y, Araki F, Sugimoto K, Nagahara M, Matsui H, Fushimi K, Yasunaga H, Aihara M, Toyama T, Ueta T. RECENT TRENDS IN THE CUMULATIVE INCIDENCE AND INTERVENTION PATTERNS OF RETINOPATHY OF PREMATURITY IN JAPAN: A Multicenter Analysis, 2011-2020. Retina 2024; 44:295-305. [PMID: 37903446 DOI: 10.1097/iae.0000000000003970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 10/16/2023] [Indexed: 11/01/2023]
Abstract
PURPOSE To investigate recent trends in the cumulative incidence and treatment patterns of retinopathy of prematurity (ROP) in Japan. METHODS A retrospective multicenter cohort was conducted from 2011 to 2020 using the Diagnosis Procedure Combination inpatient database. Preterm newborns with birth weight <2,500 g were categorized by birth weight. The cumulative incidence of ROP, treatment patterns, and association between treatment and birth weight were investigated. RESULTS A total of 82,683 preterm infants were identified, of whom 9,335 (11.3%) were diagnosed with ROP. The cumulative incidence of ROP increased by 15% in those with birth weight <500 g over the study period. Among the ROP infants, 20.2% received treatment, including laser photocoagulation (94.8%), intravitreal injection (3.8%), or both (1.8%). The proportion receiving laser photocoagulation decreased followed by an increase in intravitreal injection. This shift in intervention pattern was most conspicuous for those with birth weight 750 to 1,249 g. The risk ratio of receiving laser and intravitreal injection for those weighing <500 g was 24.7 (95% confidence interval, 10.5-58.2) and 28.4 (5.8-138.1), respectively, as compared with infants weighing >1,500 g. CONCLUSION The cumulative incidence of ROP increased in infants with birth weight <500 g. A shift from laser photocoagulation to intravitreal injection was observed in the more recent years.
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Grants
- 21AA2007 Ministry of Health, Labor, and Welfare, Japan
- 22AA2003 Ministry of Health, Labor, and Welfare, Japan
- 20H03907 Ministry of Education, Culture, Sports, Science, and Technology, Japan
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Affiliation(s)
- Han Peng Zhou
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
| | - Yohei Hashimoto
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; and
| | - Fumiyuki Araki
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
| | - Koichiro Sugimoto
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
| | - Masako Nagahara
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; and
| | - Kiyohide Fushimi
- Health Policy and Informatics Section, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; and
| | - Makoto Aihara
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
| | - Taku Toyama
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
| | - Takashi Ueta
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
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Lee KN, Yun S, Park SY, Kim K, Lee KY, Lee JJ, Son GH. Factors Associated with Spontaneous Preterm Birth after Ultrasound-Indicated Cerclage. J Pers Med 2023; 13:1678. [PMID: 38138905 PMCID: PMC10744759 DOI: 10.3390/jpm13121678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Ultrasound-indicated cerclage (UIC) is recommended to prevent spontaneous preterm birth (sPTB) in women with a short cervix at mid-trimester and a history of PTB. We assessed the factors related to sPTB after UIC and determined the corresponding risks. This retrospective cohort study was conducted at a university hospital. UIC was performed between 15 and 26 weeks of gestation in women with a cervical length of <2.5 cm. Univariate and multivariate analyses were used to examine factors associated with sPTB after UIC. An earlier gestational age and shorter cervical length at UIC were associated with sPTB after UIC. While PTB history was not associated with an increased risk of sPTB, it did increase the risk of repeat cerclage after UIC. Higher levels of preoperative serum inflammatory markers and obesity significantly increased the risk of sPTB after UIC. These findings provide helpful guidance for patient counseling and management in predicting the delivery timing after UIC in women with a short cervix in the mid-trimester.
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Affiliation(s)
- Kyong-No Lee
- Department of Obstetrics and Gynecology, Chungnam National University Hospital, Daejeon 35015, Republic of Korea;
| | - Sangho Yun
- Institute of New Frontier Research Team, College of Medicine, Hallym University, Chuncheon 24252, Republic of Korea; (S.Y.); (J.J.L.)
| | - So-Yoon Park
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea; (S.-Y.P.); (K.K.); (K.-Y.L.)
| | - Kyoungseon Kim
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea; (S.-Y.P.); (K.K.); (K.-Y.L.)
| | - Keun-Young Lee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea; (S.-Y.P.); (K.K.); (K.-Y.L.)
| | - Jae Jun Lee
- Institute of New Frontier Research Team, College of Medicine, Hallym University, Chuncheon 24252, Republic of Korea; (S.Y.); (J.J.L.)
- Departments of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Chuncheon 24252, Republic of Korea
| | - Ga-Hyun Son
- Institute of New Frontier Research Team, College of Medicine, Hallym University, Chuncheon 24252, Republic of Korea; (S.Y.); (J.J.L.)
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea; (S.-Y.P.); (K.K.); (K.-Y.L.)
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Boileau P, Letouzey M, Morgan AS, Lorthe E, Kaminski M, Coquelin A, Azria E, Caeymaex L, Rouget F, Diguisto C, Claris O, Tosello B, Truffert P, Bétrémieux P, Benhammou V, Marchand-Martin L, Goffinet F, Ancel PY, Foix-L'Hélias L. Circumstances, causes and timing of death in extremely preterm infants admitted to NICU: The EPIPAGE-2 study. Acta Paediatr 2023; 112:2066-2074. [PMID: 37402152 DOI: 10.1111/apa.16894] [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: 02/08/2023] [Revised: 05/10/2023] [Accepted: 06/28/2023] [Indexed: 07/06/2023]
Abstract
AIM To describe the circumstances, causes and timing of death in extremely preterm infants. METHODS We included from the EPIPAGE-2 study infants born at 24-26 weeks in 2011 admitted to neonatal intensive care units (NICU). Vital status and circumstances of death were used to define three groups of infants: alive at discharge, death with or without withholding or withdrawing life-sustaining treatment (WWLST). The main cause of death was classified as respiratory disease, necrotizing enterocolitis, infection, central nervous system (CNS) injury, other or unknown. RESULTS Among 768 infants admitted to NICU, 224 died among which 89 died without WWLST and 135 with WWLST. The main causes of death were respiratory disease (38%), CNS injury (30%) and infection (12%). Among the infants who died with WWLST, CNS injury was the main cause of death (47%), whereas respiratory disease (56%) and infection (20%) were the main causes in case of death without WWLST. Half (51%) of all deaths occurred within the first 7 days of life, and 35% occurred within 8 and 28 days. CONCLUSION The death of extremely preterm infants in NICU is a complex phenomenon in which the circumstances and causes of death are intertwined.
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Affiliation(s)
- Pascal Boileau
- Department of Neonatal Pediatrics, Poissy Saint Germain Hospital, Versailles Saint Quentin en Yvelines University, Poissy, France
| | - Mathilde Letouzey
- Department of Neonatal Pediatrics, Poissy Saint Germain Hospital, Versailles Saint Quentin en Yvelines University, Poissy, France
- Université Paris Cité, Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Université Paris Cité, Paris, France
| | - Andrei S Morgan
- Université Paris Cité, Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Université Paris Cité, Paris, France
- Department of Neonatology, North Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
- Elizabeth Garrett Anderson Institute for Women's Health London, University College London, London, UK
| | - Elsa Lorthe
- Université Paris Cité, Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Université Paris Cité, Paris, France
- Unit of Population Epidemiology, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Monique Kaminski
- Université Paris Cité, Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Université Paris Cité, Paris, France
| | - Anaëlle Coquelin
- Université Paris Cité, Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Université Paris Cité, Paris, France
| | - Elie Azria
- Université Paris Cité, Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Université Paris Cité, Paris, France
- Department of Obstetrics, Saint-Joseph Hospital, Paris, France
| | - Laurence Caeymaex
- Department of Neonatal Pediatrics and Intensive Care, CHI, CRC, Créteil, France
| | - Florence Rouget
- Department of Neonatal Pediatrics, University Hospital Rennes, Rennes, France
| | - Caroline Diguisto
- Université Paris Cité, Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Université Paris Cité, Paris, France
- Department of Gynecology and Obstetrics, University hospital Tours, Tours, France
| | - Olivier Claris
- Hospices Civils de Lyon, Department of Neonatology, Claude Bernard University, Lyon, France
| | - Barthélémy Tosello
- Department of Neonatology, North Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
- Aix-Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Patrick Truffert
- Department of Neonatal Medicine, Jeanne de Flandre Hospital, CHRU Lille, Lille, France
| | - Pierre Bétrémieux
- Department of Neonatal Pediatrics, University Hospital Rennes, Rennes, France
| | - Valérie Benhammou
- Université Paris Cité, Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Université Paris Cité, Paris, France
| | - Laetitia Marchand-Martin
- Université Paris Cité, Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Université Paris Cité, Paris, France
| | - François Goffinet
- Université Paris Cité, Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Université Paris Cité, Paris, France
- Department of Gynecology and Obstetrics, Port-Royal Hospital, APHP, Paris, France
| | - Pierre-Yves Ancel
- Université Paris Cité, Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Université Paris Cité, Paris, France
- Center for Clinical Investigation P1419, APHP, APHP Centre-Université Paris Cité, Paris, France
| | - Laurence Foix-L'Hélias
- Université Paris Cité, Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Université Paris Cité, Paris, France
- Department of Neonatal Pediatrics, Trousseau Hospital, APHP, Sorbonne Université, Paris, France
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Horiike M, Mimura H, Yokoi A. Prognosis and clinical issues of esophageal atresia in extremely low birth weight neonates: a case series. BMC Pediatr 2023; 23:401. [PMID: 37587404 PMCID: PMC10428575 DOI: 10.1186/s12887-023-04237-1] [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: 02/22/2023] [Accepted: 08/08/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Esophageal atresia (EA) in extremely low birth weight (ELBW) neonates is rare. This report aims to clarify EA's clinical courses and prognosis in ELBW neonates and the clinical issues of long-term survival cases. METHODS A retrospective analysis was conducted for 8 neonates diagnosed with esophageal atresia. Medical records of ELBW EA neonates treated at our institution were reviewed to assess patient demographics, clinical courses, and outcomes. Transferred patient data was obtained from their local physicians through questionnaires. RESULTS EA in ELBW neonates were included in 8 of EA infants (7%). Fatal respiratory and cardiovascular complications of trisomy 18 and complications related to immaturity such as liver failure and pulmonary hypertension were associated with poor prognosis. During primary operations, gastrostomy and esophageal banding were performed together in 50% of the cases, while gastrostomy was performed alone in 25%. The esophageal anastomosis was not performed during any primary operation. All causes of death, except for 1 case, were due to non-surgical causes. A long-term survival case of 17 years postoperatively was included. CONCLUSION Although ELBW EA has a poor prognosis, long-term survival is possible in some cases, so aggressive therapeutic intervention is considered essential. It is important to share information about the prognosis with parents and multidisciplinary specialists and to select an appropriate treatment strategy for each case.
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Affiliation(s)
- Masaki Horiike
- Department of Pediatric Surgery, Hyogo Prefectural Kobe Children's Hospital, 650-0047 1-6-7, Minatojima Minamimachi, Chuo-Ku, Kobe, Japan.
| | - Hitomi Mimura
- Department of Neonatal Medicine, Hyogo Prefectural Kobe Children's Hospital, 650-0047 1-6-7, Minatojima Minamimachi, Chuo-Ku, Kobe, Japan
| | - Akiko Yokoi
- Department of Pediatric Surgery, Hyogo Prefectural Kobe Children's Hospital, 650-0047 1-6-7, Minatojima Minamimachi, Chuo-Ku, Kobe, Japan
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7
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Ishida S, Nakanishi H, Kosaka Y, Yamaguchi A, Ooka M. Evaluation of newborns with Down syndrome with weight less than 1500 g in the neonatal intensive care unit: A Japanese multicentre study. J Paediatr Child Health 2023; 59:912-918. [PMID: 37114469 DOI: 10.1111/jpc.16418] [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: 05/01/2022] [Revised: 02/05/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
AIM This study aimed to clarify the characteristics and their mortality-related factors in very low birthweight infants with Down syndrome (DS) in Japan. METHODS This retrospective case-control study enrolled newborns with DS weighing <1500 g admitted to neonatal intensive care unit (NICU) of the perinatal centre registered with the Neonatal Research Network of Japan (NRNJ) database from 2008 to 2019. The clinical characteristics and their mortality-related factors were compared among the Dead group (newborns with DS who died in the NICU), the Survival group (newborns with DS who were alive from the NICU) and the Control group (newborns without congenital or chromosomal condition). RESULTS A total of 53 656 newborns weighing <1500 g were registered in the NRNJ database for 12 years. Of these, 310 (0.6%) were diagnosed with DS: 62 newborns in the Dead group, 248 in the Survival group and 49 786 in the Control group without chromosomal condition. Logistic analysis revealed that there was a significant difference in the mortality-related factors in congenital anomalies, pulmonary haemorrhage and persistent pulmonary hypertension of the newborn; the adjusted odds ratios were 8.6, 121 and 9.5, respectively. Newborns with DS weighing <1000 g showed the earliest death in the NICU on the Kaplan-Meier survival curve (P < 0.01). CONCLUSION The mortality rate for newborns with DS weighing <1500 g was 20% (5% in the Control group). The mortality-related factors were complications of congenital anomalies, pulmonary haemorrhage and persistent pulmonary hypertension of the newborn.
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Affiliation(s)
- Shuji Ishida
- Department of Pediatrics of Kitasato University Hospital, Sagamihara-shi, Kanagawa, Japan
| | - Hidehiko Nakanishi
- Division of Neonatal Intensive Care Medicine, Research and Development Center for New Medical Frontiers of Kitasato University Hospital, Sagamihara-shi, Kanagawa, Japan
| | - Yukako Kosaka
- Department of Pediatrics of Kitasato University Hospital, Sagamihara-shi, Kanagawa, Japan
| | - Ayano Yamaguchi
- Department of Pediatrics of Kitasato University Hospital, Sagamihara-shi, Kanagawa, Japan
| | - Mari Ooka
- Department of Pediatrics of Kitasato University Hospital, Sagamihara-shi, Kanagawa, Japan
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Wang XL, Leung E, Fung GPG, Lam HS. Gestational age-specific neonatal mortality in Hong Kong: a population-based retrospective study. World J Pediatr 2023; 19:158-169. [PMID: 36409452 DOI: 10.1007/s12519-022-00633-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/05/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The neonatal period is the most vulnerable period during childhood, with the risk of death being the highest even in developed countries/regions. Hong Kong's neonatal mortality (1‰) is among the world's lowest and has remained similar for 15 years. This study aimed to explore neonatal deaths in Hong Kong in detail and determine whether neonatal mortality is reducible at such a low level. METHODS Live births in public hospitals in Hong Kong during 01 Jan 2006-31 Dec 2017 were included. Relevant data were extracted from the electronic medical records. Gestational age-specific mortality was calculated, and the trends were analyzed using the Cochran-Armitage trend test. Causes of death were summarized, and risk factors were identified in multivariate logistic regression analysis. RESULTS In 490,034 live births, 755 cases (1.54‰) died during the neonatal period, and 293 (0.6‰) died during the post-neonatal period. The neonatal mortality remained similar overall (P = 0.17) and among infants born at 24-29 weeks' gestation (P = 0.4), while it decreased in those born at 23 (P = 0.04), 30-36 (P < 0.001) and ≥ 37 (P < 0.001) weeks' gestation. Neonates born at < 27 weeks' gestation accounted for a significantly increased proportion among cases who died (27.6% to 51.9%), with hemorrhagic conditions (24%) being the leading cause of death. Congenital anomalies were the leading cause of death in neonates born ≥ 27 weeks' gestation (52%), but its cause-specific mortality decreased (P = 0.002, 0.6‰ to 0.41‰), with most of the decrease attributed to trisomy 13/18 and multiple anomalies. CONCLUSION Reduction of neonatal mortality in developed regions may heavily rely on improved quality of perinatal and neonatal care among extremely preterm infants.
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Affiliation(s)
- Xue-Lian Wang
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eman Leung
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Genevieve Po Gee Fung
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hugh Simon Lam
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Department of Paediatrics, 6/F Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Sha Tin, New Territories, Hong Kong SAR, China.
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9
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Miyazawa T, Arahori H, Ohnishi S, Shoji H, Matsumoto A, Wada YS, Takahashi N, Takayanagi T, Toishi S, Nagaya K, Hasegawa H, Hayakawa M, Hida M, Fukuhara R, Yamada Y, Kawai M, Takashi K, Wada K, Morioka I, Mizuno K. Mortality and morbidity of extremely low birth weight infants in Japan, 2015. Pediatr Int 2023; 65:e15493. [PMID: 36740921 DOI: 10.1111/ped.15493] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/10/2023] [Accepted: 02/02/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND In Japan, the mortality rate of extremely low birth weight (ELBW) infants is notably low in comparison with other developed countries, but the prevalence of chronic lung disease (CLD) and retinopathy of prematurity (ROP) is relatively high. This study aimed to estimate the mortality and morbidity of ELBW infants born in 2015 who were admitted to neonatal intensive care units (NICUs) in Japan and to examine the factors that affected the short-term outcomes of these infants. We also compared the mortality of ELBW infants born in 2005, 2010, and 2015. METHODS We analyzed the mortality, morbidity, and factors related to short-term outcomes of ELBW infants, using data from 2782 infants born in 2015 and registered at NICUs in Japan. RESULTS The mortality rates during NICU stays were 17.0%, 12.0%, and 9.8% for ELBW infants born in 2005, 2010, and 2015, respectively. Among ELBW infants born in 2015, multiple logistic regression analysis showed that short gestational age and low birthweight Z-score contributed to the increased risk of death. Births by cesarean section and antenatal corticosteroid administration were significantly associated with a reduced risk of death. Among infants who survived, CLD was observed in 53.1% and ROP requiring treatment was observed in 30.4%. CONCLUSIONS Mortality in ELBW infants decreased significantly from 2005 to 2015. As CLD and ROP may affect quality of life and long-term outcomes of infants who survived, prevention strategies and management for these complications are critical issues in neonatal care in Japan.
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Affiliation(s)
- Tokuo Miyazawa
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Hitomi Arahori
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoshi Ohnishi
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hromichi Shoji
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Atsushi Matsumoto
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics, Iwate Medical University School of Medicine, Iwate, Japan
| | - Yuka Sano Wada
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Neonatology, National Center for Child Health and Development, Tokyo, Japan
| | - Naoto Takahashi
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Toshimitsu Takayanagi
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics, National Hospital Organization, Saga National Hospital, Saga, Japan
| | - Satoshi Toishi
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Neonatology, Japanese Red Cross Narita Hospital, Chiba, Japan
| | - Ken Nagaya
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Division of Neonatology, Center for Maternity and Infant Care, Asahikawa Medical University Hospital, Hokkaido, Japan
| | - Hisaya Hasegawa
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Division of Neonatal Intensive Care, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Masahiro Hayakawa
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Mariko Hida
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Rie Fukuhara
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Neonatology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Yasumasa Yamada
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Perinatal and Neonatal Medicine, Aichi Medical University Hospital, Aichi, Japan
| | - Masahiko Kawai
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kusaka Takashi
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Kazuko Wada
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Neonatology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Ichiro Morioka
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Katsumi Mizuno
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
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10
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Zhao T, Griffith T, Zhang Y, Li H, Hussain N, Lester B, Cong X. Early-life factors associated with neurobehavioral outcomes in preterm infants during NICU hospitalization. Pediatr Res 2022; 92:1695-1704. [PMID: 35338349 PMCID: PMC9509490 DOI: 10.1038/s41390-022-02021-y] [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] [Received: 07/08/2021] [Revised: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND The aim of this study was to investigate the influence of early-life pain/stress and medical characteristics on neurobehavioral outcomes in preterm infants. METHODS A prospective cohort study was conducted with 92 preterm infants (28-32 weeks gestational age [GA]). Early-life pain/stress was measured via the Neonatal Infant Stressor Scale (NISS) during the first 28 days of NICU hospitalization. Neurobehavioral outcomes were evaluated using the NICU Network Neurobehavioral Scale at 36-38 weeks post-menstrual age. Functional regression and machine learning models were performed to investigate the predictors of neurobehavioral outcomes. RESULTS Infants experienced daily acute pain/stress (24.99 ± 7.13 frequencies) and chronic events (41.13 ± 17.81 h). Up to 12 days after birth, both higher acute and chronic NISS scores were associated with higher stress scores; and higher chronic NISS scores were also related to lower self-regulation and quality of movement. Younger GA predicted worse neurobehavioral outcomes; GA < 31.57 weeks predicted worse stress/abstinence, self-regulation, and excitability; GA < 30.57 weeks predicted poor quality of movement. A higher proportion of maternal breastmilk intake predicted better self-regulation, excitability, and quality of movement in older GA infants. CONCLUSIONS Preterm infants are vulnerable to the impact of early-life pain/stress. Neurobehavioral outcomes are positively associated with increased GA and higher maternal breastmilk intake. IMPACT During the first 12 days of life, preterm infant neurobehavioral outcomes were vulnerable to the negative impact of acute and chronic pain/stress. Future research is warranted to investigate the long-term effects of early-life pain/stress on neurobehavioral outcomes. Gestational age remains one of the critical factors to predict neurobehavioral outcomes in preterm infants; older gestational age significantly predicted better neurobehavioral outcomes. Feeding with a higher proportion of maternal breastmilk predicted better neurobehavioral outcomes. Future research is warranted to investigate how maternal breastmilk may buffer the negative effects of early-life pain/stress on neurobehavioral outcomes.
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Affiliation(s)
- Tingting Zhao
- School of Nursing, University of Connecticut, Storrs, CT, USA
| | - Thao Griffith
- Department of Family and Community Health Nursing, Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA
| | - Yiming Zhang
- Department of Statistics, University of Connecticut, Storrs, CT, USA
| | - Hongfei Li
- Department of Statistics, University of Connecticut, Storrs, CT, USA
| | - Naveed Hussain
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
- Division of Neonatology, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Barry Lester
- Brown Center for the Study of Children at Risk, Departments of Psychiatry and Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Xiaomei Cong
- School of Nursing, University of Connecticut, Storrs, CT, USA.
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA.
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11
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Kiatchoosakun P, Jirapradittha J, Paopongsawan P, Techasatian L, Lumbiganon P, Thepsuthammarat K, Sutra S. Mortality and Comorbidities in Extremely Low Birth Weight Thai Infants: A Nationwide Data Analysis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121825. [PMID: 36553269 PMCID: PMC9776691 DOI: 10.3390/children9121825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022]
Abstract
This is the first nationwide study aimed to evaluate in-hospital mortality and comorbidities of extremely low birth weight (ELBW) infants in Thailand between 2015-2020. Data of ELBW infants were collected from the National Health Coverage Scheme. The incidence of ELBW Thai infants was 1.75 per 1000 live births. Sixty-five percent of ELBW infants were delivered in tertiary-care facilities, with 63% surviving until discharge. In-hospital mortality was 36.9%. Non-invasive respiratory supports were documented in just 17.6% of the study population, whereas total parenteral nutrition was used in 52.3% of neonates. There were several comorbidities, with the three most frequent including respiratory distress syndrome (70.7%), neonatal jaundice (66.7%), and sepsis (60.4%). The median hospitalization cost for one ELBW infant who survived was 296,438.40 baht ($8719). Conclusion: Thailand had an acceptable ELBW infant survival rate (63%), but comorbidities remained particularly severe and cost one hundred times the median hospital cost for one ELBW infant that survived in comparison to a normal newborn infant. Better health outcomes require strategies to raise awareness of the issues and the appropriate implementation of evidence-based solutions, particularly improving neonatal care facilities, as well as early referral of high-risk pregnant women and neonates, which will aid in the future reduction of neonatal morbidities and mortalities.
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Affiliation(s)
- Pakaphan Kiatchoosakun
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
- Correspondence: ; Tel.: +66-43-363012
| | - Junya Jirapradittha
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Pongsatorn Paopongsawan
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Leelawadee Techasatian
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Pagakrong Lumbiganon
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Kaewjai Thepsuthammarat
- Clinical Epidemiology Unit, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Sumitr Sutra
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
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12
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Debere MK, Haile Mariam D, Ali A, Mekasha A, Chan GJ. Survival status and predictors of mortality among low-birthweight neonates admitted to KMC units of five public hospitals in Ethiopia: Frailty survival regression model. PLoS One 2022; 17:e0276291. [PMID: 36355701 PMCID: PMC9648734 DOI: 10.1371/journal.pone.0276291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/04/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Low birth weight (LBW) and preterm birth are leading causes of under-five and neonatal mortality globally. Data about the timing of death and outcomes for LBW and preterm births are limited in Ethiopia and could be used to strengthen neonatal healthcare. This study describes the incidence of neonatal mortality rates (NMR) stratified by newborn size at birth for gestational age and identifies its predictors at five public hospitals in Ethiopia. METHODS A prospective follow-up study enrolled 808 LBW neonates from March 2017 to February 2019. Sex-specific birthweight for gestational age percentile was constructed using Intergrowth 21st charts. Mortality patterns by birthweight for-gestational-age-specific survival curves were compared using the log-rank test and Kaplan-Meier survival curves. A random-effects frailty survival model was employed to identify predictors of time to death. RESULTS Among the 808 newborns, the birthweight distribution was 3.2% <1000 g, 28.3% <1500 g, and 68.1% <2000 g, respectively. Birthweight for gestational age categories were 40.0% both preterm and small for gestational age (SGA), 20.4% term SGA, 35.4% appropriate weight for gestational age, and 4.2% large for gestational age (LGA). The sample included 242 deaths, of which 47.5% were both preterm and SGA. The incidence rate of mortality was 16.17/1000 (95% CI 14.26-18.34) neonatal-days of observation. Neonatal characteristics independently related to increased risk of time-to-death were male sex (adjusted hazards ratio [AHR] 3.21 95% CI 1.33-7.76), born preterm (AHR 8.56 95% CI 1.59-46.14), having been diagnosed with a complication (AHR 4.68 95% CI 1.49-14.76); some maternal characteristics and newborn care practices (like lack of effective KMC, AHR 3.54 95% CI 1.14-11.02) were also significantly associated with time-to-death. CONCLUSIONS High mortality rates were measured for low birthweight neonates-especially those both preterm and SGA births-even in the context of tertiary care. These findings highlight the need for improved quality of neonatal care, especially for the smallest newborns.
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Affiliation(s)
- Mesfin Kote Debere
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Damen Haile Mariam
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmed Ali
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Amha Mekasha
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Grace J. Chan
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
- Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of Amrica
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13
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Dettmeyer R. Extremely Preterm Babies-Legal Aspects and Palliative Care at the Border of Viability. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1594. [PMID: 36291530 PMCID: PMC9600655 DOI: 10.3390/children9101594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022]
Abstract
There are various legal considerations and rare decisions of courts in western countries concerning palliative care and the border of viability in cases of extremely preterm babies. Nevertheless, on the one hand, regulations and decisions of courts describe the conditions physicians have to accept. On the other hand, courts are also able to accept that every case can be special, and needs a unique answer. Therefore, the framework can be described as well as the medical disciplines, which should be involved in a particular case.
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Affiliation(s)
- Reinhard Dettmeyer
- Institute of Forensic Medicine, Justus-Liebig-University Giessen, Frankfurter Str. 58, D-35392 Gießen, Germany
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14
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Jia CH, Feng ZS, Lin XJ, Cui QL, Han SS, Jin Y, Liu GS, Yang CZ, Ye XT, Dai YH, Liang WY, Ye XZ, Mo J, Ding L, Wu BQ, Chen HX, Li CW, Zhang Z, Rong X, Huang WM, Shen W, Yang BY, Lv JF, Huo LY, Huang HW, Rao HP, Yan WK, Yang Y, Ren XJ, Liu D, Wang FF, Diao SG, Liu XY, You CM, Meng Q, Wang B, Zhang LJ, Huang YG, Ao D, Li WZ, Chen JL, Chen YL, Li W, Chen ZF, Ding YQ, Li XY, Huang YF, Lin NY, Cai YF, Wan ZH, Ban Y, Bai B, Li GH, Yan YX, Wu F. Short term outcomes of extremely low birth weight infants from a multicenter cohort study in Guangdong of China. Sci Rep 2022; 12:11119. [PMID: 35778441 PMCID: PMC9249781 DOI: 10.1038/s41598-022-14432-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/07/2022] [Indexed: 02/05/2023] Open
Abstract
With the increase in extremely low birth weight (ELBW) infants, their outcome attracted worldwide attention. However, in China, the related studies are rare. The hospitalized records of ELBW infants discharged from twenty-six neonatal intensive care units in Guangdong Province of China during 2008-2017 were analyzed. A total of 2575 ELBW infants were enrolled and the overall survival rate was 55.11%. From 2008 to 2017, the number of ELBW infants increased rapidly from 91 to 466, and the survival rate improved steadily from 41.76% to 62.02%. Increased survival is closely related to birth weight (BW), regional economic development, and specialized hospital. The incidence of complications was neonatal respiratory distress syndrome (85.2%), oxygen dependency at 28 days (63.7%), retinopathy of prematurity (39.3%), intraventricular hemorrhage (29.4%), necrotizing enterocolitis (12.0%), and periventricular leukomalacia (8.0%). Among the 1156 nonsurvivors, 90.0% of infants died during the neonatal period (≤ 28 days). A total of 768 ELBW infants died after treatment withdrawal, for reasons of economic and/or poor outcome. The number of ELBW infants is increasing in Guangdong Province of China, and the overall survival rate is improving steadily.
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Affiliation(s)
- Chun-Hong Jia
- Department of Pediatrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China
- Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangzhou, 510150, Guangdong, China
| | - Zhou-Shan Feng
- Department of Pediatrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China
| | - Xiao-Jun Lin
- Department of Pediatrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China
| | - Qi-Liang Cui
- Department of Pediatrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China
| | - Sha-Sha Han
- Department of Neonatology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Ya Jin
- Department of Neonatology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Guo-Sheng Liu
- Department of Neonatology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Chuan-Zhong Yang
- Department of Neonatology, Shenzhen Maternal and Child Healthcare Hospital, Affiliated Southern Medical University, Shenzhen, 518028, Guangdong, China
| | - Xiao-Tong Ye
- Department of Neonatology, Shenzhen Maternal and Child Healthcare Hospital, Affiliated Southern Medical University, Shenzhen, 518028, Guangdong, China
| | - Yi-Heng Dai
- Department of Neonatology, Foshan Maternal and Child's Hospital, Foshan, 528000, Guangdong, China
| | - Wei-Yi Liang
- Department of Neonatology, Foshan Maternal and Child's Hospital, Foshan, 528000, Guangdong, China
| | - Xiu-Zhen Ye
- Department of Neonatology, Women and Children Hospital of Guangdong Province, Guangzhou, 510010, Guangdong, China
| | - Jing Mo
- Department of Neonatology, Women and Children Hospital of Guangdong Province, Guangzhou, 510010, Guangdong, China
| | - Lu Ding
- Department of Neonatology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China
| | - Ben-Qing Wu
- Department of Neonatology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China
| | - Hong-Xiang Chen
- Department of Neonatology, Meizhou People's Hospital, Meizhou, 514031, Guangdong, China
| | - Chi-Wang Li
- Department of Neonatology, Meizhou People's Hospital, Meizhou, 514031, Guangdong, China
| | - Zhe Zhang
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou, 510120, Guangdong, China
| | - Xiao Rong
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou, 510120, Guangdong, China
| | - Wei-Min Huang
- Department of Neonatology, Nanfang Hospital of Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Wei Shen
- Department of Neonatology, Nanfang Hospital of Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Bing-Yan Yang
- Department of Neonatology, Boai Hospital of Zhongshan, Zhongshan, 528400, Guangdong, China
| | - Jun-Feng Lv
- Department of Neonatology, Boai Hospital of Zhongshan, Zhongshan, 528400, Guangdong, China
| | - Le-Ying Huo
- Department of Neonatology, Zhuhai Maternity and Child Health Hospital, Zhuhai, 519001, Guangdong, China
| | - Hui-Wen Huang
- Department of Neonatology, Zhuhai Maternity and Child Health Hospital, Zhuhai, 519001, Guangdong, China
| | - Hong-Ping Rao
- Department of Neonatology, Huizhou Municipal Central Hospital, Huizhou, 516001, Guangdong, China
| | - Wen-Kang Yan
- Department of Neonatology, Huizhou Municipal Central Hospital, Huizhou, 516001, Guangdong, China
| | - Yong Yang
- Department of Neonatology, Dongguan Maternity and Child Health Hospital, Dongguan, 523002, Guangdong, China
| | - Xue-Jun Ren
- Department of Neonatology, Dongguan Maternity and Child Health Hospital, Dongguan, 523002, Guangdong, China
| | - Dong Liu
- Department of Neonatology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, 529000, Guangdong, China
| | - Fang-Fang Wang
- Department of Neonatology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, 529000, Guangdong, China
| | - Shi-Guang Diao
- Department of Neonatology, Yuebei People's Hospital, Shaoguan, 512026, Guangdong, China
| | - Xiao-Yan Liu
- Department of Neonatology, Yuebei People's Hospital, Shaoguan, 512026, Guangdong, China
| | - Chu-Ming You
- Department of Neonatology, Guangdong Second Provincial People's Hospital, Guangzhou, 510317, Guangdong, China
| | - Qiong Meng
- Department of Neonatology, Guangdong Second Provincial People's Hospital, Guangzhou, 510317, Guangdong, China
| | - Bin Wang
- Department of Pediatrics, Zhujiang Hospital of Southern Medical University, Guangzhou, 510280, Guangdong, China
| | - Li-Juan Zhang
- Department of Pediatrics, Zhujiang Hospital of Southern Medical University, Guangzhou, 510280, Guangdong, China
| | - Yu-Ge Huang
- Department of Pediatrics, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, Guangdong, China
| | - Dang Ao
- Department of Pediatrics, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, Guangdong, China
| | - Wei-Zhong Li
- Department of Neonatology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Jie-Ling Chen
- Department of Neonatology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Yan-Ling Chen
- Department of Neonatology, Jinan University Medical College Affiliated Dongguan Hospital, Dongguan, 523900, Guangdong, China
| | - Wei Li
- Department of Neonatology, Jinan University Medical College Affiliated Dongguan Hospital, Dongguan, 523900, Guangdong, China
| | - Zhi-Feng Chen
- Department of Pediatrics, Dongguan People's Hospital, Dongguan, 523000, Guangdong, China
| | - Yue-Qin Ding
- Department of Pediatrics, Dongguan People's Hospital, Dongguan, 523000, Guangdong, China
| | - Xiao-Yu Li
- Department of Neonatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Yue-Fang Huang
- Department of Neonatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Ni-Yang Lin
- Department of Neonatology, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Yang-Fan Cai
- Department of Neonatology, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Zhong-He Wan
- Department of Neonatology, Nanhai District People's Hospital of Foshan, Foshan, 528200, Guangdong, China
| | - Yi Ban
- Department of Neonatology, Nanhai District People's Hospital of Foshan, Foshan, 528200, Guangdong, China
| | - Bo Bai
- Department of Neonatology, Huadu District People's Hospital of Guangzhou, Guangzhou, 510800, Guangdong, China
| | - Guang-Hong Li
- Department of Neonatology, Huadu District People's Hospital of Guangzhou, Guangzhou, 510800, Guangdong, China
| | - Yue-Xiu Yan
- Department of Pediatrics, The First People's Hospital of Zhaoqing, Zhaoqing, 526020, Guangdong, China
| | - Fan Wu
- Department of Pediatrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China.
- Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangzhou, 510150, Guangdong, China.
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15
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Growth Trajectories during the First 6 Years in Survivors Born at Less Than 25 Weeks of Gestation Compared with Those between 25 and 29 Weeks. J Clin Med 2022; 11:jcm11051418. [PMID: 35268509 PMCID: PMC8911231 DOI: 10.3390/jcm11051418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/30/2022] Open
Abstract
We aimed to determine the differences in the growth trajectories of the youngest gestational survivors (<25 weeks’ gestation) up to 6 years of age compared to those of older gestational ages. Preterm infants were divided into two groups: 22−24 weeks’ gestation (male (M) 16, female (F) 28) and 25−29 weeks’ gestation (M 84, F 59). Z-scores of body weight (BW), body length (BL), and body mass index (BMI) were derived from Japanese standards at 1, 1.5, 3, and 6 years of corrected age. Comparisons between the two groups by sex were made using the Wilcoxon test and linear regression analysis to examine the longitudinal and time-point associations of anthropometric z-scores, the presence of small for gestational age (SGA), and the two gestational groups. BW, BL, BMI, and z-scores were significantly lower in the 22−24 weeks group at almost all assessment points. However, there were no significant differences in BW, BL, BMI, and z-scores between the two female groups after 3 years. BMI z-scores were significantly associated with the youngest gestational age and the presence of SGA at all ages in males, but not in females. The youngest gestational age had a greater influence in males on the z-score of anthropometric parameters up to 6 years of age.
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16
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Incidence of Intrapartum-Related Events at the Largest Obstetric Hospital in Hanoi, Vietnam: A Retrospective Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030321. [PMID: 35327693 PMCID: PMC8947411 DOI: 10.3390/children9030321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
Abstract
Every year, 2.4 million neonates die during their first month of life and even more suffer permanent injury. The main causes are intrapartum-related events, prematurity, and infection, with sub-Saharan Africa and southern Asia being the worst affected regions. With a focus on intrapartum-related events, we aimed to assess the neonatal demographic characteristics, clinical management, and outcomes among neonates born at the largest obstetric hospital in Hanoi, Vietnam. This was a retrospective cross-sectional study that included all the inborn neonates in November 2019, which was selected as a representative month. A total of 4554 neonates were born during the study period. Of these, 1.0% (n = 44) were stillbirths, 0.15% (n = 7) died in hospital, 0.61% (n = 28) received positive pressure ventilation at birth, and 0.15% (n = 7) were diagnosed with hypoxic ischemic encephalopathy. A total of 581 (13%) neonates were admitted to the neonatal unit, among which the most common diagnoses were prematurity (37%, n = 217) and infection (15%, n = 89). Except for the intrapartum-related events, our findings are consistent with the previously documented data on neonatal morbidity. The intrapartum-related events, however, were surprisingly low in number even in comparison to high-income countries. Research on the current clinical practice at Phu San Hanoi Hospital may bring further clarity to identify the success factors.
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17
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Kusuda S, Hirano S, Nakamura T. Creating experiences from active treatment towards extremely preterm infants born at less than 25 weeks in Japan. Semin Perinatol 2022; 46:151537. [PMID: 34862068 DOI: 10.1016/j.semperi.2021.151537] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Treatment for extremely preterm infants born at less than 25 weeks of gestation in Japan was initiated mainly due to the amendment of the Maternal Health Act lowering the upper limit of abortion from 24 weeks to 22 weeks in 1990. Five years after the amendment, the Japanese national government started a nationwide project to improve the perinatal care system. Once selected perinatal centers reported improvements in survival rates, more centers have adopted aggressive treatments. They have accumulated their knowledge by experiencing the treatment of infants with a limit of viability. As a result, more than 50% of infants born even at 22 weeks of gestation can survive to discharge currently. This progress has resulted from the accumulation of experience at each perinatal center rather than the results from clinical trials. Furthermore, these experiences have been standardized to some extent through sharing information.
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Affiliation(s)
- Satoshi Kusuda
- Specialist Doctor, Department of Pediatrics, Kyorin University, Tokyo, Japan.
| | - Shinya Hirano
- Associate Director, Department of Neonatology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Tomohiko Nakamura
- Director, Department of Neonatology, Nagano Children's Hospital, Nagano, Japan
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18
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Sawada Y, Honda N, Narumiya M, Mizumoto H. Evaluation of the social skills of low birthweight infants using the Interaction Rating Scale. J Phys Ther Sci 2022; 34:697-703. [PMID: 36213188 PMCID: PMC9535250 DOI: 10.1589/jpts.34.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to examine, using the Interaction Rating Scale, the effect of
social skills at 18 months of life on the subsequent development of low birthweight
infants. [Participants and Methods] The study participants were made up of a total of 23
infants who were admitted to the neonatal intensive care unit of Hospital A and whose
developmental indexes were followed up at the outpatient clinic for up to 3 years of age.
The survey was conducted twice in each infant, at a corrected age of 18 months and at 36
full months of age. Social skills and developmental indexes were assessed at the corrected
age of 18 months, meanwhile only developmental indexes were assessed at 36 full months, to
examine associations. The Interaction Rating Scale was used to assess social skills. This
scale measures various aspects of social development by observing caregiver-child
interactions in situations wherein children are engaged in tasks more difficult for their
age. [Results] The results demonstrated that social skills at 18 months were associated
with the developmental indexes at 18 and 36 months, whereas more items were associated
with the developmental index at 36 months. [Conclusion] The results indicate the need for
early prediction of developmental delay and timely intervention, by assessing social
skills in low birthweight infants.
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Affiliation(s)
- Yuko Sawada
- Department of Physical Therapy, Morinomiya University of Medical Sciences: 1-26-16 Nanko-kita, Suminoe-ku, Osaka 559-8611, Japan
| | - Noritsugu Honda
- Department of Physical Therapy, Morinomiya University of Medical Sciences: 1-26-16 Nanko-kita, Suminoe-ku, Osaka 559-8611, Japan
| | - Makiko Narumiya
- Department of Pediatrics, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Japan
| | - Hiroshi Mizumoto
- Rehabilitation Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Japan
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Awata K, Shoji H, Santosa I, Ikeda N, Murano Y, Ohkawa N, Nishizaki N, Hisata K, Kantake M, Obinata K, Shimizu T. Associations between size at birth and size at 6 years among preterm infants: a retrospective cohort study. Pediatr Int 2022; 64:e14844. [PMID: 33999477 DOI: 10.1111/ped.14844] [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: 10/27/2020] [Revised: 04/30/2021] [Accepted: 05/12/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Little is known about the relationship between fetal growth and size at school age in children born prematurely. We evaluated the relationships between gestational age and anthropometric z-scores at birth and size at 6 years of age in very-low-birthweight infants born at <30 weeks' gestation. METHODS We collected data from the medical records of 187 preterm children at birth and 6 years of age. We evaluated correlations between gestational age and z-scores for weight, body length, and head circumference at birth and z-scores for weight, height, and body mass index at 6 years of age. RESULTS Simple regression analysis showed that, in boys and the overall group, gestational age and z-scores for weight, body length, and head circumference at birth had significant association with z-scores for weight, height, and body mass index at 6 years of age. No significant associations were found in girls, except for weight z-scores at 6 years with gestational age and head circumference z-scores at birth. Multiple regression analysis showed that gestational age and length z-score at birth were significantly and independently associated with weight and height z-score at 6 years. Gestational age was also significantly and independently associated with body mass index z-score at 6 years. CONCLUSION Gestational age and fetal growth in length (assessed with the birth-length z-score) were associated with anthropometric z-scores at 6 years in very-low-birthweight children born at <30 weeks of gestation, especially in boys.
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Affiliation(s)
- Kentaro Awata
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiromichi Shoji
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Irena Santosa
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Naho Ikeda
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yayoi Murano
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Natsuki Ohkawa
- Department of Neonatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Naoto Nishizaki
- Department of Pediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Ken Hisata
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Masato Kantake
- Department of Neonatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Kaoru Obinata
- Department of Pediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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20
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Itoshima R, Oda A, Ogawa R, Yanagisawa T, Hiroma T, Nakamura T. Respiratory and Gastrointestinal Management of an Infant with a Birth Weight of 258 Grams. AJP Rep 2022; 12:e89-e95. [PMID: 35154903 PMCID: PMC8828450 DOI: 10.1055/a-1678-3755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/20/2021] [Indexed: 11/25/2022] Open
Abstract
Today, more infants weighing less than or equal to 300 g are born, and they survive because of the improvements in neonatal care and treatment. However, their detailed clinical course and neonatal intensive care unit management remain unknown due to their low survival rate and dearth of reports. A male infant was born at 24 weeks and 5 days of gestation and weighed 258 g. The infant received 72 days of invasive and 92 days of noninvasive respiratory support, including high-frequency oscillatory ventilation with volume guarantee and noninvasive neurally adjusted ventilatory assist. Meconium-related ileus was safely treated using diatrizoate. Although the infant was diagnosed with severe bronchopulmonary dysplasia and retinopathy of prematurity requiring laser photocoagulation, he had no other severe complications. He was discharged 201 days postdelivery (3 months of corrected age) with a weight of 3.396 kg. Although managing infants weighing less than or equal to 300 g is difficult, our experience shows that it is possible by combining traditional and modern management methods. The management of such infants requires an understanding of the expected difficulties and adaptation of existing methods to their management. The management techniques described here should help improve their survival and long-term prognosis.
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Affiliation(s)
- Ryo Itoshima
- Division of Neonatology, Nagano Children's Hospital, Nagano, Japan.,Department of Pediatrics, University of Turku, Turku, Finland
| | - Arata Oda
- Division of Neonatology, Nagano Children's Hospital, Nagano, Japan
| | - Ryo Ogawa
- Division of Neonatology, Nagano Children's Hospital, Nagano, Japan
| | | | - Takehiko Hiroma
- Division of Neonatology, Nagano Children's Hospital, Nagano, Japan
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21
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Bedside Transcatheter Patent Ductus Arteriosus Device Occlusion in an Extremely Low Birth Weight Neonate: A Novel Approach in a High-Risk Population. Case Rep Anesthesiol 2021; 2021:4716997. [PMID: 34745665 PMCID: PMC8566062 DOI: 10.1155/2021/4716997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/18/2021] [Indexed: 11/20/2022] Open
Abstract
Extremely low birth weight (ELBW) infants weighing less than 1 kilogram are at a high-risk for delayed patent ductus arteriosus (PDA) closure. Percutaneous PDA closure offers a less invasive approach when compared with surgical PDA closure, which may provide faster recovery times and less transfusion requirements. However, this procedure involves transporting tenuous, unstable patients from the neonatal intensive care unit (NICU) to the catheterization laboratory which introduces many potential risks for the neonate. Performing percutaneous PDA closure at the bedside offers a successful alternative to performing the procedure in the catheterization laboratory and avoiding risk associated with transporting ELBW neonates.
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22
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Murano Y, Shoji H, Ikeda N, Okawa N, Hayashi K, Kantake M, Morisaki N, Shimizu T, Gilmour S. Analysis of Factors Associated With Body Mass Index at Ages 18 and 36 Months Among Infants Born Extremely Preterm. JAMA Netw Open 2021; 4:e2128555. [PMID: 34648012 PMCID: PMC8517745 DOI: 10.1001/jamanetworkopen.2021.28555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
IMPORTANCE The development of neonatology has been associated with improved survival among infants born extremely preterm, and understanding their long-term outcomes is becoming increasingly important. However, there is little information on body mass index (BMI) among these children. OBJECTIVE To determine factors associated with BMI at ages 18 months and 36 months among infants born extremely preterm. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study was conducted using data from the Neonatal Research Network Japan database for 8838 infants born at gestational ages 23 to 28 weeks with data on BMI at 18 months and 36 months. Data were analyzed from April 2018 through June 2021. EXPOSURES BMI and BMI z score at ages 18 months and 36 months were regressed with gestational age, intrauterine growth restriction (IUGR) status, and complications during pregnancy and the neonatal period separately by presence of multiple pregnancy and sex. MAIN OUTCOMES AND MEASURES BMI and BMI z score at ages 18 months and 36 months. RESULTS Among 16 791 eligible infants born extremely preterm, 8838 infants were included in the analysis. There were 7089 infants born from single pregnancies (mean [SD] gestational age, 26.0 [1.6] weeks; 3769 [53.2%] boys; mean [SD] birth weight, 847 [228] g) and 1749 infants born from multiple pregnancies (mean [SD] gestational age, 26.3 [1.5] weeks; 903 [51.6%] boys; mean [SD] birth weight, 860 [217] g). In single pregnancies, every week of increased gestational age was associated with an increase in BMI of 0.21 (95% CI, 0.17-0.25) among boys and 0.20 (95% CI, 0.15-0.25) among girls at age 18 months and 0.21 (95% CI, 0.18-0.24) among boys and 0.21 (95% CI, 0.18-0.24) among girls at age 36 months. There was an interaction association between gestational age and IUGR among boys at age 36 months, with a decrease in the change associated with gestational age of 0.12 (95% CI, 0.05-0.19). Every week of increased gestational age in single pregnancies was associated with an increase in BMI z score of 0.14 (95% CI, 0.17-0.21) among boys and 0.17 (95% CI, 0.13-0.21) among girls at age 18 months and 0.19 (95% CI, 0.16-0.22) among boys and 0.17 (95% CI, 0.15-0.20) among girls at age 36 months. Among single pregnancies, IUGR was associated with a decrease in BMI among boys (0.59 [95% CI, 0.23-0.95]) and girls (0.75 [95% CI, 0.39-1.11]) and BMI z score among boys 0.85 [95% CI, 0.25-0.95)] and girls (0.67 [95% CI, 0.36-0.97] at age 18 months and BMI among boys (0.44 [95% CI, 0.17-0.18]) and girls (0.84 [95% CI, 0.55-1.12]) and BMI z score among boys (0.46 [95% CI, 0.21-0.71]) and girls (0.77 [95% CI, 0.53-1.01]) at age 36 months. In multiple pregnancies, IUGR was associated with a decrease in BMI z score at age 36 months among boys (0.26 [95% CI, 0.42-0.89]) and girls (0.29 [95% CI, 0.22-0.79]). In single pregnancies intraventricular hemorrhage (IVH) was associated with a decrease in BMI of 0.47 (95% CI, 0.21-0.73) among boys and 0.42 (95% CI, 0.13-0.71) among girls at age 18 months and 0.53 (95% CI, 0.32-0.74) among boys and 0.31 (95% CI, 0.07-0.54) among girls at age 36 months. IVH was associated with a decrease in BMI z score in single pregnancies of 0.63 (95% CI, 0.20-0.41) among boys and 0.35 (95% CI, 0.12-0.60) among girls at age 18 months and 0.53 (95% CI, 0.34-0.71) among boys and 0.30 (95% CI, 0.11-0.50) among girls at age 36 months. Similar associations were seen in multiple pregnancies. CONCLUSIONS AND RELEVANCE This study found that gestational age, the presence of IUGR and multiple pregnancy, and IVH complications were associated with infant BMI at ages 18 months and 36 months. These findings suggest that these complicating factors should be considered when setting growth targets and nutrition strategies for infants born extremely preterm.
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Affiliation(s)
- Yayoi Murano
- Department of Pediatrics, Juntendo University Faculty of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
- Graduate School of Public Health, St. Luke’s International University, Akashi-cho, Chuo-ku, Tokyo, Japan
| | - Hiromichi Shoji
- Department of Pediatrics, Juntendo University Faculty of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Naho Ikeda
- Department of Pediatrics, Juntendo University Faculty of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Natsuki Okawa
- Department of Pediatrics, Juntendo University Faculty of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kuniyoshi Hayashi
- Graduate School of Public Health, St. Luke’s International University, Akashi-cho, Chuo-ku, Tokyo, Japan
| | - Masato Kantake
- Department of Pediatrics, Juntendo University Faculty of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, Okura, Setagaya-ku, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Juntendo University Faculty of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Stuart Gilmour
- Graduate School of Public Health, St. Luke’s International University, Akashi-cho, Chuo-ku, Tokyo, Japan
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23
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Saikusa M, Kinoshita M, Tsuda K, Hisano T, Okada J, Iwata S, Fujino H, Maeno Y, Yamashita Y, Iwata O. Revisions of clinical protocols using the Plan Do Check Act cycle improved outcomes of extremely preterm infants at 2 years. Acta Paediatr 2021; 110:2100-2109. [PMID: 33711173 PMCID: PMC8360062 DOI: 10.1111/apa.15840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/04/2021] [Accepted: 03/10/2021] [Indexed: 11/28/2022]
Abstract
AIM Clinical quality improvement is often cumbersome due to established protocols. We aimed to investigate whether outcomes of preterm infants improve with protocol revisions using iteration cycles. METHODS Preterm infants born <28 weeks gestation between January 2006 and December 2015 were retrospectively analysed. Protocols were revised using Plan Do Check Act cycle. Death and serious adverse events at term were reviewed in six-monthly quality improvement meetings. Adverse outcome of death or motor/sensory impairments at two years was compared before and after two major protocol changes, which were implemented in January 2008 and January 2012. RESULTS Based on the appraisal for period 2006-2007, strategies for surfactant, narcotics, parenteral nutrition, respiratory gas humidity and prophylactic indomethacin and antibiotics were changed for period 2008-2011. For period 2012-2015, stabilisation of infants was accelerated via very early catheterisation. Of 162 infants (84 males, 25.5 ± 1.5 weeks gestation) within the whole cohort, 63 developed adverse outcomes, which were fewer for periods 2008-2011 (p = 0.013) and 2012-2015 (p = 0.035) compared with period 2006-2007 (adjusted for gestational age, Apgar scores and sex). CONCLUSION Careful bottom-up revisions of protocols using iteration cycles, accounting for local settings, successfully improved the outcomes of preterm infants.
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Affiliation(s)
- Mamoru Saikusa
- Department of Paediatrics and Child HealthKurume University School of MedicineKurumeFukuokaJapan
| | - Masahiro Kinoshita
- Department of Paediatrics and Child HealthKurume University School of MedicineKurumeFukuokaJapan
| | - Kennosuke Tsuda
- Department of Paediatrics and Child HealthKurume University School of MedicineKurumeFukuokaJapan
- Center for Human Development and Family ScienceDepartment of Pediatrics and NeonatologyNagoya City University Graduate School of Medical SciencesNagoyaAichiJapan
| | - Tadashi Hisano
- Center for Human Development and Family ScienceDepartment of Pediatrics and NeonatologyNagoya City University Graduate School of Medical SciencesNagoyaAichiJapan
| | - Junichiro Okada
- Department of Paediatrics and Child HealthKurume University School of MedicineKurumeFukuokaJapan
| | - Sachiko Iwata
- Department of Paediatrics and Child HealthKurume University School of MedicineKurumeFukuokaJapan
- Center for Human Development and Family ScienceDepartment of Pediatrics and NeonatologyNagoya City University Graduate School of Medical SciencesNagoyaAichiJapan
| | - Hiroshi Fujino
- Department of Paediatrics and Child HealthKurume University School of MedicineKurumeFukuokaJapan
| | - Yasuki Maeno
- Department of Paediatrics and Child HealthKurume University School of MedicineKurumeFukuokaJapan
| | - Yushiro Yamashita
- Department of Paediatrics and Child HealthKurume University School of MedicineKurumeFukuokaJapan
| | - Osuke Iwata
- Department of Paediatrics and Child HealthKurume University School of MedicineKurumeFukuokaJapan
- Center for Human Development and Family ScienceDepartment of Pediatrics and NeonatologyNagoya City University Graduate School of Medical SciencesNagoyaAichiJapan
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24
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Kono Y. Neurodevelopmental outcomes of very low birth weight infants in the Neonatal Research Network of Japan: importance of neonatal intensive care unit graduate follow-up. Clin Exp Pediatr 2021; 64:313-321. [PMID: 33171036 PMCID: PMC8255508 DOI: 10.3345/cep.2020.01312] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/19/2020] [Indexed: 11/30/2022] Open
Abstract
Here we describe the neurodevelopmental outcomes of very low birth weight (VLBW) infants (birth weight ≤1,500 g) at 3 years of age in the Neonatal Research Network of Japan (NRNJ) database in the past decade and review the methodological issues identified in follow-up studies. The follow-up protocol for children at 3 years of chronological age in the NRNJ consists of physical and comprehensive neurodevelopmental assessments in each participating center. Neurodevelopmental impairment (NDI)-moderate to severe neurological disability-is defined as cerebral palsy (CP) with a Gross Motor Function Classification System score ≥2, visual impairment such as uni- or bilateral blindness, hearing impairment requiring hearing amplification, or cognitive impairment with a developmental quotient (DQ) of Kyoto Scale of Psychological Development score <70 or judgment as delayed by pediatricians. We used death or NDI as an unfavorable outcome in all study subjects and NDI in survivors using number of assessed infants as the denominator. Follow-up data were collected from 49% of survivors in the database. Infants with follow-up data had lower birth weights and were of younger gestational age than those without followup data. Mortality rates of 40,728 VLBW infants born between 2003 and 2012 were 8.2% before discharge and 0.7% after discharge. The impairment rates in the assessed infants were 7.1% for CP, 1.8% for blindness, 0.9% for hearing impairment, 15.9% for a DQ <70, and 19.1% for NDI. The mortality or NDI rate in all study subjects, including infants without followup data, was 17.4%, while that in the subjects with outcome data was 32.5%. The NRNJ follow-up study results suggested that children born with a VLBW remained at high risk of NDI in early childhood. It is important to establish a network followup protocol and complete assessments with fewer dropouts to enable clarification of the outcomes of registered infants.
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Affiliation(s)
- Yumi Kono
- Department of Pediatrics, Jichi Medical University, Shimotsuke Tochigi, Japan
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25
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Mitani Y, Kubota A, Goda T, Kato H, Watanabe T, Riko M, Tsuno Y, Kumagai T, Yamaue H. Optimum therapeutic strategy for meconium-related ileus in very-low-birth-weight infants. J Pediatr Surg 2021; 56:1117-1120. [PMID: 33896618 DOI: 10.1016/j.jpedsurg.2021.03.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND/PURPOSE therapeutic strategy for meconium-related ileus (MRI) in very-low-birth-weight infants (VLBWs) has not been established. This study aims to clarify the optimum therapeutic strategy for MRI in VLBWs. METHODS MRI was defined as delayed meconium excretion and microcolon on contrast enema with Gastrografin (diatrizoate acid). Forty-two infants with MRI were treated at our institution between 2009 and 2019, and are reviewed here. They were classified into two groups: in group A (n=21), Gastrografin regurgitated into the dilated intestine during the first or second round of Gastrografin enema (GaE), while in group B (N = 21), Gastrografin did not regurgitate. Laparotomy was indicated if the intestine was perforated, or if abdominal distention was not relieved by two rounds of GaE. RESULTS in group A, meconium was excreted in all cases within 24 h after GaE, and no cases required laparotomy. In group B, twelve cases (57%) underwent laparotomy (P < 0.01), six cases in this group (29%), showed free air on X-ray images (P < 0.01). The median hospital stay in groups A and B were 89.0 and 136.5 days, respectively (P < 0.05). Overall mortality was 2.4%. CONCLUSIONS early therapeutic diagnosis by GaE followed by early surgery is suggested as the optimum strategy for MRI in VLBWs.
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Affiliation(s)
- Yasuyuki Mitani
- Second Department of Surgery, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama 641-8510, Japan
| | - Akio Kubota
- Second Department of Surgery, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama 641-8510, Japan
| | - Taro Goda
- Second Department of Surgery, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama 641-8510, Japan
| | - Hirotaka Kato
- Second Department of Surgery, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama 641-8510, Japan
| | - Takashi Watanabe
- Second Department of Surgery, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama 641-8510, Japan
| | - Mitsuhiko Riko
- Neonatology, Maternal and Perinatal Care Center, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama 641-8510, Japan
| | - Yoshinobu Tsuno
- Neonatology, Maternal and Perinatal Care Center, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama 641-8510, Japan
| | - Takeshi Kumagai
- Neonatology, Maternal and Perinatal Care Center, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama 641-8510, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama 641-8510, Japan.
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26
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Nishizaki N, Shima T, Watanabe A, Obinata K, Shimizu T. Unsatisfactory Short-Term Neurodevelopmental Outcomes of Preterm Infants Who Received Polymyxin B-Immobilized Fiber Column-Direct Hemoperfusion for Septic Shock. TOHOKU J EXP MED 2021; 253:275-281. [PMID: 33896891 DOI: 10.1620/tjem.253.275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Sepsis and septic shock are associated with high mortality and neurodevelopmental impairment in preterm infants. Recently, endotoxin and mediator removal using a polymyxin B-immobilized fiber column for direct hemoperfusion (PMX-DHP) has been used for the management of septic shock even in neonates. Although early withdrawal from shock with PMX-DHP contributes to survival, its effect on neurodevelopment after discharge is unclear. This study aimed to examine short-term neurodevelopmental impairment in preterm infants with septic shock who were treated with PMX-DHP. We retrospectively assessed five infants who received treatment with PMX-DHP (median 25.5 [interquartile range: 24.8-28.3] weeks and 817 [interquartile range: 667-954] g). Neurodevelopmental outcomes were assessed with the Kyoto Scale of Psychological Development 2001 at a median 34.5 (interquartile range: 29.5-44.5) months of corrected age after discharge. The short-term neurodevelopmental prognosis of preterm infants treated with PMX-DHP for septic shock was delayed (overall developmental quotient < 70) with an average quotient of 57.3. Furthermore, four (80%) of five patients presented with intraventricular hemorrhage and another four (80%) with periventricular leukomalacia. In conclusion, preterm infants with septic shock treated with PMX-DHP had unsatisfactory short-term neurodevelopmental outcomes. Hence, the effect of PMX-DHP in improving neurodevelopmental prognosis even in preterm infants with septic shock should be further evaluated.
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Affiliation(s)
- Naoto Nishizaki
- Department of Pediatrics, Juntendo University Urayasu Hospital
| | - Taiki Shima
- Department of Pediatrics, Juntendo University Urayasu Hospital
| | - Akiko Watanabe
- Department of Pediatrics, Juntendo University Urayasu Hospital
| | - Kaoru Obinata
- Department of Pediatrics, Juntendo University Urayasu Hospital
| | - Toshiaki Shimizu
- Department of Pediatrics, Juntendo University Faculty of Medicine
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Itabashi K, Miyazawa T, Kusuda S, Wada K. Changes in mortality rates among extremely preterm infants born before 25 weeks' gestation: Comparison between the 2005 and 2010 nationwide surveys in Japan. Early Hum Dev 2021; 155:105321. [PMID: 33548820 DOI: 10.1016/j.earlhumdev.2021.105321] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/14/2021] [Accepted: 01/17/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is no consensus as to whether the outcomes of extremely preterm infants born <25 weeks' gestation have been constantly improving. AIMS Our study aimed to clarify changes in mortality during hospitalization among extremely preterm infants. STUDY DESIGN Comparison of mortality rates between the 2005 and 2010 retrospective nationwide surveys in Japan. SUBJECTS Extremely preterm infants born <25 weeks' gestation in Japan and registered in the nationwide surveys, 802 infants in 2005 and 797 in 2010, respectively. OUTCOMES Mortality rates stratified by gestational age. RESULTS AND CONCLUSION Mortality rates <25 weeks' gestation decreased from 36.4% to 25.6% (difference - 10.8% [95% confidence interval {CI}: -15.3%, -6.2%]) in 2010 compared to 2005. Gestational age-specific mortality rates were lower in 2010 compared to 2005, except for 24 weeks' gestation: 66.0% vs. 50.0% (difference: -16% [95% CI: -29.8%, -21.2%]) and 45.7% vs. 25.5% (difference: -20.2%, [95% CI: -28.1, -12.3%]) at 22, and 23 weeks' gestation, respectively. After adjusting for explanatory variables, the probability of death during hospitalization in 2010 was significantly lower in infants born <25 weeks' gestation (adjusted odds ratio [aOR] 0.597 [95% CI: 0.471, 0.757], but when stratified by gestational age, it was only significant for infants born at 23 weeks' gestation (aOR 0.439 [95% CI: 0.303, 0.636]). In conclusion, the mortality rates among infants born <25 weeks' gestation have been steadily improving from 2005 to 2010 in Japan, but the practice for infants born at 22 weeks' gestation is still challenging.
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Affiliation(s)
- Kazuo Itabashi
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan.
| | - Tokuo Miyazawa
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Satoshi Kusuda
- Department of Pediatrics, Kyorin University School of Medicine, Tokyo, Japan
| | - Kazuko Wada
- Department of Pediatrics, Osaka Women's and Children's Hospital, Osaka, Japan
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28
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Pan M, Fang JN, Wang XX, Zhang J, Lin Z. Predictors of cerclage failure in singleton pregnancies with a history of preterm birth and a sonographic short cervix. Int J Gynaecol Obstet 2021; 156:316-321. [PMID: 33544891 DOI: 10.1002/ijgo.13640] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/23/2021] [Accepted: 02/03/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify predictors of ultrasound-indicated cerclage failure in singleton pregnancies for preventing extremely preterm birth. METHODS A retrospective cohort study included 96 singleton pregnancies with ultrasound-indicated McDonald cerclage in women with previous preterm birth (PTB) and cervical shortening. Descriptive statistics were calculated at baseline and logistic regression analyses were performed to identify the factors associated with cerclage failure. RESULTS In all, 28 (29%) of the women had a preterm delivery at before 28 weeks. Multivariate analysis identified cervical dilatation, non-cephalic presentation, and platelet-lymphocyte ratio (PLR) as independent predictors of cerclage failure (odds ratio [OR] 3.12, 95% CI [confidence interval] 1.01-9.66; OR 5.81, 95% CI 1.04-32.53; OR 1.02, 95% CI 1.01-1.03, respectively). The efficacy of these predictors was evaluated using a receiver operating characteristics curve. The area under the curve was 0.87 (95% CI 0.78-0.96, P < 0.001) with a sensitivity of 78.6% and specificity of 88.2%. CONCLUSION Our findings indicated that cervical dilatation, fetal presentation, and PLR were valuable predictors of cerclage failure in singleton pregnancies with a history of PTB and a sonographic short cervix. The results can be potentially used to assess the prognosis of patients after cerclage and alert clinicians to consider enhanced surveillance and administration of individuals at an increased risk.
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Affiliation(s)
- Mian Pan
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jiao-Ning Fang
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiao-Xiao Wang
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jun Zhang
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhi Lin
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Morgan AS, Waheed S, Gajree S, Marlow N, David AL. Maternal and infant morbidity following birth before 27 weeks of gestation: a single centre study. Sci Rep 2021; 11:288. [PMID: 33431902 PMCID: PMC7801674 DOI: 10.1038/s41598-020-79445-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/30/2020] [Indexed: 11/09/2022] Open
Abstract
Delivery at extreme preterm gestational ages (GA) [Formula: see text] weeks is challenging with limited evidence often focused only on neonatal outcomes. We reviewed management and short term maternal, fetal and neonatal outcomes of births for 132 women (22 + 0 to 26 + 6 weeks' GA) with a live fetus at admission to hospital and in labour or at planned emergency Caesarean section: 103 singleton and 29 (53 live fetuses) twin gestations. Thirty women (23%) had pre-existing medical problems, 110 (83%) had antenatal complications; only 17 (13%) women experienced neither. Major maternal labour and delivery complications affected 35 women (27%). 151 fetuses (97%) were exposed to antenatal steroids, 24 (15%) to tocolysis and 70 (45%) to magnesium sulphate. Delivery complications affected 11 fetuses, with 12 labour or delivery room deaths; survival to discharge was 75% (117/156), increasing with GA: 25% (1/4), 75% (18/24), 69% (29/42), 73% (33/45) and 88% (36/41) at 22, 23, 24, 25 and 26 weeks GA respectively (p = 0.024). No statistically important impact was seen from twin status, maternal illness or obstetric management. Even in a specialist perinatal unit antenatal and postnatal maternal complications are common in extreme preterm births, emphasising the need to include maternal as well as neonatal outcomes.
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Affiliation(s)
- Andrei S Morgan
- Research Department of Neonatology, Elizabeth Garrett Anderson Institute for Women's Health, University College London, 2nd floor, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK.,INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Hôpital Tenon, Rue de la Chine, 75020, Paris, France.,SAMU 93-SMUR Pédiatrique, CHI André Gregoire, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, Assistance Publique des Hôpitaux de Paris, Montreuil, France.,Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Saadia Waheed
- Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Shivani Gajree
- Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Neil Marlow
- Research Department of Neonatology, Elizabeth Garrett Anderson Institute for Women's Health, University College London, 2nd floor, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK.,Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK.,NIHR University College London Hospitals BRC, Maple House, 149 Tottenham Court Road, London, W1T 7DN, UK
| | - Anna L David
- Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK. .,NIHR University College London Hospitals BRC, Maple House, 149 Tottenham Court Road, London, W1T 7DN, UK. .,Research Department of Maternal Fetal Medicine, Institute for Women's Health, University College London, 2nd floor, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK.
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30
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Kurimoto T, Ibara S, Kamitomo M, Tokuhisa T, Maeda T, Maede Y, Ishihara C, Naito Y, Hirakawa E, Yamamoto T, Yamamoto M, Kibe M, Takayama T, Ohashi H. Risk Factors for Mortality and Neurodevelopmental Impairment among Neonates Born at 22-23 Weeks' Gestation. Neonatology 2021; 118:310-316. [PMID: 33744873 DOI: 10.1159/000514161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/28/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to evaluate the risk factors for mortality and neurodevelopmental impairment (NDI) among infants of 22-23 weeks' gestational age, which currently remain unclear. METHODS This retrospective case-control study included 104 infants delivered at 22-23 weeks' gestation at Kagoshima City Hospital from 2006 to 2015. We compared 65 and 34 cases of survival to discharge and postnatal in-hospital death (5 excluded), respectively, and 26 and 35 cases with and without NDI, respectively, using maternal, prenatal, and postnatal records. A high rate of survivors' follow-up (61/65) was achieved in this study. RESULTS The survival rate was 75.0% (21/28) and 62.0% (44/71) among infants born at 22 and 23 weeks' gestation, respectively. Infants who died weighed less (525.5 vs. 578 g, p = 0.04) and their intrauterine growth retardation (IUGR) rate (<5th percentile) was higher (14.7 vs. 1.5%, p = 0.02). Mortality was associated with an increased incidence of bradycardia on fetal heart rate monitoring (11.8 vs. 1.5%, p = 0.046), periventricular hemorrhagic infarction (PVHI; 32.4 vs. 6.2%, p = 0.001), necrotizing enterocolitis (NEC, surgery or drain tube; 14.7 vs. 0.0%, p = 0.004), and tension pneumothorax (29.4 vs. 6.2%, p = 0.004). There were significant differences in the proportion of PVHI (15.4 vs. 0%, p = 0.03) between infants with and without NDI. CONCLUSIONS IUGR, bradycardia, PVHI, NEC, and tension pneumothorax were associated with neonatal mortality among infants born at 22-23 weeks' gestation. NDI at 36-42 months' chronological age was associated with PVHI.
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Affiliation(s)
- Tomonori Kurimoto
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan,
| | - Satoshi Ibara
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| | - Masato Kamitomo
- Department of Obstetrics and Gynecology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| | - Takuya Tokuhisa
- Department of Neonatology, Perinatal Medical Center, Imakiire General Hospital, Kagoshima, Japan
| | - Takatsugu Maeda
- Department of Obstetrics and Gynecology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| | - Yoshinobu Maede
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| | - Chie Ishihara
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| | - Yoshiki Naito
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| | - Eiji Hirakawa
- Department of Neonatology, Perinatal Medical Center, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Tsuyoshi Yamamoto
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| | - Masakatsu Yamamoto
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| | - Masaya Kibe
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| | - Tatsu Takayama
- Department of Neonatology, Perinatal Medical Center, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Hiroshi Ohashi
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
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31
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Onuma S, Ida S, Maeyama T, Shoji Y, Etani Y, Kawai M. Growth hormone treatment for extremely low birthweight children born small for gestational age. Pediatr Int 2021; 63:46-52. [PMID: 32594610 DOI: 10.1111/ped.14363] [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: 08/22/2019] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The effectiveness of growth hormone (GH) treatment for height gain in short-stature children born small for gestational age (SGA) with extremely low birthweight (ELBW; birthweight <1,000 g) remains largely unknown. METHODS In study 1, 35 prepubertal Japanese children born SGA with ELBW were categorized into three groups based on the presence or absence of catch-up growth by age 3 (CU(+) and CU(-), respectively) and GH treatment (GH(+) and GH(-), respectively). Height standard deviation (SD) scores (HT-SDS) in the CU-/GH+ group (n = 19) were compared with those in the age-matched CU+/GH- (n = 9) and CU-/GH- groups (n = 7). In study 2, 66 prepubertal Japanese SGA children treated with GH were divided into three groups by birthweight: <1,000 g (n = 19), 1,000-2,000 g (n = 20), and >2,000 g (n = 27). Changes in HT-SDS during the initial 3 years of GH treatment were compared among the three groups. RESULTS In study 1, the mean HT-SDS in the CU-/GH+ group (-1.15 SD) was similar to that in the CU+/GH- group (-1.39 SD) but higher than that in the CU-/GH- group (-2.24 SD). In study 2, GH achieved a height gain of +1.62 SD in the ELBW group, which was similar to that in the other groups (1,000-2,000 g: +1.46 SD, >2,000 g: +1.53 SD). CONCLUSIONS Growth hormone treatment in short-stature children born SGA with ELBW increased HT-SDS, which was similar to that in SGA children born with a birthweight ≥1,000 g. These results indicate that GH treatment may be an effective approach to promote adequate growth recovery for short-stature children born SGA with ELBW.
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Affiliation(s)
- Shinsuke Onuma
- Department of Gastroenterology, Nutrition, and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Shinobu Ida
- Department of Gastroenterology, Nutrition, and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Takatoshi Maeyama
- Department of Gastroenterology, Nutrition, and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Yasuko Shoji
- Department of Gastroenterology, Nutrition, and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Yuri Etani
- Department of Gastroenterology, Nutrition, and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Masanobu Kawai
- Department of Gastroenterology, Nutrition, and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan.,Department of Bone and Mineral Research, Research Institute, Osaka Women's and Children's Hospital, Osaka, Japan
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Riko M, Toyoshima K, Shimokaze T, Kumagai T, Suzuki H. Clinical Presentation of Preterm Infants with Ventricular Septal Defect. TOHOKU J EXP MED 2020; 252:281-286. [PMID: 33208568 DOI: 10.1620/tjem.252.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ventricular septal defects (VSDs) are the most common congenital heart diseases; however, case reports of preterm infants with VSD are limited. The aim of this study is to share our experience with preterm infants with VSD and to record their short-term outcomes. Between January 2000 and December 2017, 32 preterm infants with VSD were admitted to our neonatal intensive care unit at gestational age < 32 weeks. Of these, 9 were excluded by exclusion criteria. The size and location of the VSD, details of treatment, and neonatal prognosis were retrospectively reviewed from the medical records. Among the 23 preterm infants, the median gestational age was 29.4 weeks (25.0-31.3 weeks) and the median birthweight was 924 g (524-1,526 g). There were 9 infants with VSD < 2 mm and 14 infants with VSD ≥ 2 mm. For the 9 infants with VSD < 2 mm, no medical or surgical treatments for VSDs were undertaken. Of the 14 infants with VSD ≥ 2 mm, 8 (57.1%) underwent medical and surgical treatment. Surgical treatment was performed more frequently in infants with VSD ≥ 2 mm than in those with VSD < 2 mm (P = 0.007). In preterm infants, the presence of VSD ≥ 2 mm increases the risk of surgical interventions and significant patent ductus arteriosus. It is important to encourage treatment for preterm infants with VSD ≥ 2 mm, including surgical interventions, in cooperation with pediatric cardiologists.
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Affiliation(s)
- Mitsuhiko Riko
- Department of Neonatology, Kanagawa Children's Medical Center.,Department of Pediatrics, Wakayama Medical University
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Hanaoka S, Iwanaga K, Tomotaki S, Niwa F, Takita J, Kawai M. Antenatal corticosteroids for threatened labour facilitate thyroid maturation among preterm neonates. Clin Endocrinol (Oxf) 2020; 93:613-619. [PMID: 32589812 DOI: 10.1111/cen.14272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine the effect of antenatal corticosteroids (ANS) on the maturation of thyroid function in the preterm infants. CONTEXT ANS reduce mortality and morbidities in preterm neonates. Organ maturation by the glucocorticoids is the key, at least in part. However, the effect of ANS on thyroid is controversial. PATIENTS A study group of 99 very low birthweight neonates (<34 weeks' gestational age) with the exception of those born more than 7 days after ANS administration were divided into a complete group (n = 49) whose mothers completed two doses of betamethasone and who were born more than 24 hours after the completion of ANS administration, and an incomplete group (n = 50) who were not exposed to any ANS or were born within 24 hours after the completion of ANS administration. Serum-free thyroxine and thyroid-stimulating hormone (TSH) levels were measured, and thyrotropin-releasing hormone (TRH) stimulation tests were performed at about 2 weeks of age. RESULTS The incidence of hyperthyrotropinaemia (TSH > 15 mIU/L) in the complete group was significantly lower than in the incomplete group (6% vs 22%, P = .023). Exaggerated responses to TRH tests were more frequent in the incomplete group (17% vs 44%; P = .053). TSH30 was significantly lower in the complete group, (P = .046). Multivariate logistic regression analysis showed that the incidence of hyperthyrotropinaemia was associated with complete ANS administration (adjusted odds ratios 0.39). CONCLUSIONS ANS administration might facilitate thyroid maturation in preterm neonates.
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Affiliation(s)
- Shintaro Hanaoka
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kogoro Iwanaga
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Seiichi Tomotaki
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Fusako Niwa
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Junko Takita
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahiko Kawai
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Yamauchi T, Imamura M, Takasawa K, Nakajima K, Nakagawa R, Gau M, Sugie M, Taki A, Kawai M, Kashimada K, Morio T. Prematurity at less than 24 weeks of gestation is a risk for prolonged hyperglycemia in extremely low-birth weight infants. Endocrine 2020; 70:71-77. [PMID: 32617755 DOI: 10.1007/s12020-020-02393-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 06/18/2020] [Indexed: 11/29/2022]
Abstract
Hyperglycemia in extremely low-birth weight infants (ELBWIs) is frequently observed during the acute perinatal phase, (i.e., first 1-2 weeks postnatal period); however it can occasionally persists for >2 weeks, extending to the post-acute phase. Since such prolonged hyperglycemia (PH) is not typical for ELBWIs, the aim of the present study was to further understand the clinical details of PH. Twenty-five hyperglycemic ELBWIs born before 28 weeks of gestation from 2015 to 2018 were included in the study. Based on the duration of hyperglycemia, we separated the subjects into two groups: non-prolonged hyperglycemia (NPH) who achieved remission within ≤2 weeks [n = 18, median 3.0 (range, 2.0-4.0) days], and PH, whose hyperglycemia persisted for >2 weeks [n = 7, median 50.0 (range, 33.5-66.0) days]. Compared to the NPH group, glucose metabolism of the PH group was more deteriorate. The peak blood glucose level was significantly higher in the PH group [PH: median 472 mg/dL, NPH: median 275 mg/dL, p < 0.001], and a higher proportion of subjects in the PH group required insulin therapy [PH: 100% (7/7) vs. NPH: 22% (4/22)]. Multivariate analysis revealed that among perinatal factors, prematurity was the only independent risk factor for PH (glucocorticoid therapy: p = 0.884, gestational age: p = 0.006), with a cutoff of 23W4D determined by receiver operating characteristic analysis. Our data revealed distinctive clinical features of PH, suggesting a type different from the previously reported hyperglycemia in ELBWIs. Specifically, extreme prematurity, less than 24 weeks of gestation, is a risk for PH, and aggressive interventions, such as insulin would be required.
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Affiliation(s)
- Takeru Yamauchi
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- Department of Neonatology, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masatoshi Imamura
- Department of Neonatology, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Kei Takasawa
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Keisuke Nakajima
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- Department of Pediatrics, Kashiwa Municipal Hospital, Chiba, Japan
| | - Ryuichi Nakagawa
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Maki Gau
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Manabu Sugie
- Department of Neonatology, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Atsuko Taki
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Masahiko Kawai
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenichi Kashimada
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
| | - Tomohiro Morio
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Tachikawa T, Ueno R, Mita T, Yuzurihara D, Katsumi O, Noda T, Saito M. Refractive state and visual acuity of children with extremely low birth weight at 3 years old in Japan. Jpn J Ophthalmol 2020; 64:539-548. [PMID: 32648074 DOI: 10.1007/s10384-020-00754-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 05/30/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate the refractive status and visual acuity of 3-year-old children with extremely low birth weight (ELBW). STUDY DESIGN Retrospective cohort study. METHODS We examined 161 children born between January 2009 and December 2014. The children were divided into five groups for evaluation of visual acuity and refraction: no retinopathy of prematurity (ROP), reverse ROP, photocoagulation (PC) zone II (ZII), PC (ZI), and PC (ZI + lens-sparing vitrectomy [vit]). RESULTS Median (1st quartile, 3rd quartile) gestational age was 25 (24, 26) weeks. Median birth weight was 738 (588, 846) g. Spherical equivalence (SE) was +0.38 (-0.06, +0.75) diopters (D) in no ROP, +0.63 (-0.25, +1.34) D in reverse ROP, +0.38 (-0.75, +1.31) D in PC (ZII), -3.31 (-8.06, +0.16) D in PC (ZI), and -12.00 (-13.50, -4.50) D in PC (ZI+ vit) children. Best corrected visual acuity (BCVA) in log MAR was 0.15 (0.07, 0.26) in no ROP, 0.17 (0.10, 0.30) in reverse ROP, 0.22 (0.10, 0.38) in PC (ZII), 0.45 (0.22, 0.55) in PC (ZI), and 1.10 (0.82, 1.30) in PC (ZI+ vit) children. There was a significant correlation between SE and BCVA (r = -0.43, p < 0.0001). CONCLUSION The no ROP, reverse ROP, and PC (ZII) groups showed no significant differences in SE or BCVA, accounting for 79.5% of ELBW children. SE and BCVA in the PC (ZI) and PC (ZI+ vit) groups were worse than in the other groups. The current results reveal a correlation between SE and BCVA.
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Affiliation(s)
- Takako Tachikawa
- Department of Ophthalmology, Tokyo Metropolitan Ohtsuka Hospital, Minami-Ohtsuka 2-8-1, Toshima-ku, Tokyo, Japan.
| | - Ritsuko Ueno
- Department of Ophthalmology, Tokyo Metropolitan Ohtsuka Hospital, Minami-Ohtsuka 2-8-1, Toshima-ku, Tokyo, Japan
| | - Tetsuko Mita
- Department of Ophthalmology, Tokyo Metropolitan Ohtsuka Hospital, Minami-Ohtsuka 2-8-1, Toshima-ku, Tokyo, Japan
| | - Daisuke Yuzurihara
- Department of Ophthalmology, Tokyo Metropolitan Ohtsuka Hospital, Minami-Ohtsuka 2-8-1, Toshima-ku, Tokyo, Japan
| | - Osamu Katsumi
- Department of Ophthalmology, Tokyo Metropolitan Ohtsuka Hospital, Minami-Ohtsuka 2-8-1, Toshima-ku, Tokyo, Japan
| | - Toru Noda
- Department of Ophthalmology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Makoto Saito
- Office for Clinical Research Support, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
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Nakano Y. Adult-Onset Diseases in Low Birth Weight Infants: Association with Adipose Tissue Maldevelopment. J Atheroscler Thromb 2019; 27:397-405. [PMID: 31866623 PMCID: PMC7242223 DOI: 10.5551/jat.rv17039] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Low birth weight (LBW) infants have higher risk of developing insulin resistance and its comorbidities later in life. The concept of “developmental origins of health and disease” suggests that intrauterine and postnatal environments have an important role in increasing these risks. The risk of such adult-onset diseases in LBW infants might be associated with adipose tissue maldevelopment including altered body composition and increased amount of visceral fat, which is the same mechanism as that in children and adults with metabolic syndrome. However, LBW infants often have different characteristics: they are not always overweight or obese over their life course. The inconsistency might be associated with the thrifty phenotype, which is produced in response to impaired growth potential and decreased lean body mass. LBW infants tend to be obese within the limits of impaired growth potential. Through our previous investigations evaluating longitudinal changes in adiponectin levels at an early stage of life, we speculated that probably, the intrauterine life of term infants or the period up to term-equivalent age in preterm infants might be the key age for the development of adipose tissues including fat cells. Because of that, we hypothesized that the smaller number of adipocytes in LBW infants might be associated with overloading of single adipocytes and impaired adipose tissue expandability. The possible mechanisms are discussed from the perspective of adipose tissue maldevelopment in LBW infants.
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Affiliation(s)
- Yuya Nakano
- Department of Pediatrics, Showa University School of Medicine
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37
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Kuroda Y, Uchida T, Hamasaki A, Yamashita A, Mizumoto M, Akabane K, Ishizawa A, Sadahiro M. Surgery for Acute Type A Aortic Dissection in A Pregnant Woman At 28 Weeks' Gestation. Braz J Cardiovasc Surg 2019; 34:627-629. [PMID: 31719015 PMCID: PMC6852455 DOI: 10.21470/1678-9741-2018-0225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
A 27-year-old woman with sudden back pain was transported to our hospital.
Abdominal ultrasonography revealed pregnancy of 28 weeks’ gestation. Computed
tomography demonstrated a type A aortic dissection. Because of progressive fetal
deterioration, an emergency cesarean section was forced to perform. The next
day, simple hysterectomy followed by an aortic procedure was completed.
Valve-sparing aortic replacement and total arch replacement were employed as
central operations. The mother and baby are well 9 months postoperatively.
Although the strategy for acute type A aortic dissection during pregnancy is
controversial, collaborations among neonatologists, obstetricians, and
cardiovascular surgeons can ensure mother and infant survival.
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Affiliation(s)
- Yoshinori Kuroda
- Yamagata University Faculty of Medicine Department of Surgery II Division of Cardiovascular Surgery Yamagata-shi Japan Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata-shi, Yamagata-ken, Japan
| | - Tetsuro Uchida
- Yamagata University Faculty of Medicine Department of Surgery II Division of Cardiovascular Surgery Yamagata-shi Japan Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata-shi, Yamagata-ken, Japan
| | - Azumi Hamasaki
- Yamagata University Faculty of Medicine Department of Surgery II Division of Cardiovascular Surgery Yamagata-shi Japan Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata-shi, Yamagata-ken, Japan
| | - Atsushi Yamashita
- Yamagata University Faculty of Medicine Department of Surgery II Division of Cardiovascular Surgery Yamagata-shi Japan Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata-shi, Yamagata-ken, Japan
| | - Masahiro Mizumoto
- Yamagata University Faculty of Medicine Department of Surgery II Division of Cardiovascular Surgery Yamagata-shi Japan Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata-shi, Yamagata-ken, Japan
| | - Kentaro Akabane
- Yamagata University Faculty of Medicine Department of Surgery II Division of Cardiovascular Surgery Yamagata-shi Japan Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata-shi, Yamagata-ken, Japan
| | - Ai Ishizawa
- Yamagata University Faculty of Medicine Department of Surgery II Division of Cardiovascular Surgery Yamagata-shi Japan Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata-shi, Yamagata-ken, Japan
| | - Mitsuaki Sadahiro
- Yamagata University Faculty of Medicine Department of Surgery II Division of Cardiovascular Surgery Yamagata-shi Japan Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata-shi, Yamagata-ken, Japan
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Diguisto C, Foix l'Helias L, Goffinet F. [Antenatal management and outcomes for extremely preterm newborns in France: Should we reconsider our practices?]. ACTA ACUST UNITED AC 2019; 47:880-883. [PMID: 31614230 DOI: 10.1016/j.gofs.2019.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Indexed: 10/25/2022]
Affiliation(s)
- C Diguisto
- Inserm UMR1153, Obstetrical perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risque et grossesse, Paris Descartes University, 75014 Paris, France; Maternité Olympe de Gouges, université François-Rabelais, centre hospitalier régional universitaire de Tours, 37000 Tours, France.
| | - L Foix l'Helias
- Inserm UMR1153, Obstetrical perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risque et grossesse, Paris Descartes University, 75014 Paris, France; Service de néonatologie, hôpital Armand Trousseau, Sorbonne université, AP-HP, 75012 Paris, France
| | - F Goffinet
- Inserm UMR1153, Obstetrical perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risque et grossesse, Paris Descartes University, 75014 Paris, France; Maternité Port Royal, hôpitaux Cochin Broca Hôtel-Dieu, université Paris Descartes, DHU Risque et grossesse, AP-HP, 75014 Paris, France
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Morita M, Tanaka K, Matsumura S, Tamura M, Namba F. Perinatal factors associated with bubbly/cystic appearance in bronchopulmonary dysplasia: a nationwide, population-based cohort study in Japan. J Matern Fetal Neonatal Med 2019; 34:1221-1226. [PMID: 31170848 DOI: 10.1080/14767058.2019.1628945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) remains one of the most serious morbidities associated with preterm birth. Previous study reported that bubbly/cystic appearance on chest X-rays in the neonatal period is the strongest determinant of impaired lung function at school age in BPD patients. AIMS To determine perinatal risk factors for bubbly/cystic appearance on chest X-rays in extremely premature infants with BPD exposed to histological chorioamnionitis histological chorioamnionitis (hCAM). STUDY DESIGN Multicenter retrospective cohort study. SUBJECTS We analyzed 1369 extremely premature infants with severe hCAM who were admitted to the neonatal intensive care units participating in the Neonatal Research Network, Japan (NRNJ) Neonatal research network Japan. OUTCOME MEASURES Perinatal characteristics were compared and logistic regression analysis was performed for multivariate risk factor assessment. RESULT Infants with bubbly/cystic appearance on chest X-rays underwent longer duration of invasive mechanical ventilation and required inhaled nitric oxide and home oxygen therapy more frequently. Low gestational age (odds ratio 1.244; 95% confidence interval 1.139-1.359) and preterm premature rupture of membranes (odds ratio 1.507; 95% confidence interval 1.200-1.893) were significant risk factors. CONCLUSION Low gestational age and preterm premature rupture of membranes were independent risk factors for bubbly/cystic appearance in extremely premature infants with BPD following exposure to severe hCAM.
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Affiliation(s)
- Machiko Morita
- Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Kosuke Tanaka
- Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Shun Matsumura
- Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Masanori Tamura
- Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Fumihiko Namba
- Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
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40
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Intrauterine growth restriction affects z-scores of anthropometric parameters during the first 6 years in very low-birth-weight-children born at less than 30 weeks of gestation. J Dev Orig Health Dis 2019; 11:44-48. [PMID: 31232255 DOI: 10.1017/s2040174419000369] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Little is known about physical constitution outcomes for very preterm infants. Here, we compare z-scores of anthropometric parameters up to 6 years of age in children born with very low birth weight (VLBW) at less than 30 weeks of gestation, with or without intrauterine growth restriction (IUGR). DESIGN Participants were divided into four subgroups: male (M), small for gestational age (SGA) (n = 30); M, appropriate for gestational age (AGA) (n = 59); female (F), SGA (n = 24); and F, AGA (n = 61). z-Scores of body weight (BW), body length (BL), and body mass index (BMI) were assessed at birth, 1 year corrected age, 3 years of age, and 6 years of age. RESULTS For boys, BW and BMI were significantly lower among SGA children than among AGA children at all assessments, but there was no difference in BL at 3 or 6 years. For girls, BW and BL were significantly lower among SGA children than among AGA children at all assessments, but no difference was detected in BMI after 1.5 years. No significant variation in the z-score of BW or BMI in either SGA group was observed after 1 year. BL z-score in all groups gradually increased until 6 years of age. CONCLUSION IUGR affects BW and BMI in boys and BW and BL in girls during the first 6 years in VLBW children born at less than 30 weeks of gestation. SGA children did not catch up in BW or BMI from 1 to 6 years of age.
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Myrhaug HT, Brurberg KG, Hov L, Markestad T. Survival and Impairment of Extremely Premature Infants: A Meta-analysis. Pediatrics 2019; 143:peds.2018-0933. [PMID: 30705140 DOI: 10.1542/peds.2018-0933] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2018] [Indexed: 02/04/2023] Open
Abstract
CONTEXT Survival of infants born at the limit of viability varies between high-income countries. OBJECTIVE To summarize the prognosis of survival and risk of impairment for infants born at 22 + 0/7 weeks' to 27 + 6/7 weeks' gestational age (GA) in high-income countries. DATA SOURCES We searched 9 databases for cohort studies published between 2000 and 2017 in which researchers reported on survival or neurodevelopmental outcomes. STUDY SELECTION GA was based on ultrasound results, the last menstrual period, or a combination of both, and neurodevelopmental outcomes were measured by using the Bayley Scales of Infant Development II or III at 18 to 36 months of age. DATA EXTRACTION Two reviewers independently extracted data and assessed the risk of bias and quality of evidence. RESULTS Sixty-five studies were included. Mean survival rates increased from near 0% of all births, 7.3% of live births, and 24.1% of infants admitted to intensive care at 22 weeks' GA to 82.1%, 90.1%, and 90.2% at 27 weeks' GA, respectively. For the survivors, the rates of severe impairment decreased from 36.3% to 19.1% for 22 to 24 weeks' GA and from 14.0% to 4.2% for 25 to 27 weeks' GA. The mean chance of survival without impairment for infants born alive increased from 1.2% to 9.3% for 22 to 24 weeks' GA and from 40.6% to 64.2% for 25 to 27 weeks' GA. LIMITATIONS The confidence in these estimates ranged from high to very low. CONCLUSIONS Survival without impairment was substantially lower for children born at <25 weeks' GA than for those born later.
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Affiliation(s)
| | | | - Laila Hov
- VID Specialized University, Oslo, Norway; and
| | - Trond Markestad
- Department of Clinical Science, University of Bergen and Innlandet Hospital Trust, Bergen, Norway
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Ma L, Liu C, Cheah I, Yeo KT, Chambers GM, Kamar AA, Travadi J, Oei JL. Cost is an important factor influencing active management of extremely preterm infants. Acta Paediatr 2019; 108:70-75. [PMID: 30080290 DOI: 10.1111/apa.14533] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022]
Abstract
AIM The attitudes of neonatologists towards the active management of extremely premature infants in a developing country like China are uncertain. METHODS A web-based survey was sent to neonatologists from 16 provinces representing 59.6% (824.2 million) of the total population of China on October 2015 and December 2017. RESULTS A total of 117 and 219 responses were received in 2015 and 2017, respectively. Compared to 2015, respondents in 2017 were more likely to resuscitate infants <25 weeks of gestation (86% vs. 72%; p < 0.05), but few would resuscitate infants ≤23 weeks of gestation in either epoch (10% vs. 6%). In both epochs, parents were responsible for >50% of the costs of intensive care, but in 2017, significantly fewer clinicians would cease intensive care (75% vs. 88%; p < 0.05) and more would request for economic aid (40% vs. 20%; p < 0.05) if parents could not afford to pay. Resource availability (e.g. ventilators) was not an important factor in either initiation or continuation of intensive care (~60% in both epochs). CONCLUSION Cost is an important factor in the initiation and continuation of neonatal intensive care in a developing country like China. Such factors need to be taken into consideration when interpreting outcome data from these regions.
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Affiliation(s)
- Li Ma
- Department of Neonatology Children's Hospital of Hebei Province Shijiazhuang China
| | - Cuiqing Liu
- Department of Neonatology Children's Hospital of Hebei Province Shijiazhuang China
| | - Irene Cheah
- Department of Neonatology Hospital Kuala Lumpur Kuala Lumpur Malaysia
| | - Kee Thai Yeo
- Department of Neonatology KK Women and Children's Hospital Singapore City Singapore
| | - Georgina M. Chambers
- Centre for Big Data and School of Women's and Children's Health University of New South Wales Sydney Australia
| | - Azanna Ahmad Kamar
- Department of Neonatology University of Malaya Medical Center Kuala Lumpur Malaysia
| | - Javeed Travadi
- Department of Neonatology John Hunter Hospital Newcastle NSW Australia
| | - Ju Lee Oei
- Centre for Big Data and School of Women's and Children's Health University of New South Wales Sydney Australia
- Department of Newborn Care Royal Hospital for Women Randwick NSW Australia
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Oehmke F, Lauer T, Baecker J, Mader S, Soydan N, Born T, Brumhard M, Dettmeyer R, Staszewski S, Heinemann T, Kilian U, Sarikaya Y, Kress H, Tinneberg HR, Bilgin Y, Zimmer KP, Ehrhardt H. Ethical, Legal, and Religious Aspects at the Border of Viability. Front Pediatr 2019; 7:175. [PMID: 31139602 PMCID: PMC6518665 DOI: 10.3389/fped.2019.00175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/16/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Frank Oehmke
- Department of Obstetrics and Gynecology, Justus-Liebig-University, Giessen, Germany
| | - Tina Lauer
- Department of General Pediatrics and Neonatology, Justus-Liebig-University, Giessen, Germany
| | - Johanna Baecker
- Department of General Pediatrics and Neonatology, Justus-Liebig-University, Giessen, Germany
| | - Silke Mader
- European Foundation for the Care of Newborn Infants, Munich, Germany
| | - Nedim Soydan
- Türkisch-Deutsche Gesundheitsstiftung e.V., Giessen, Germany
| | - Thomas Born
- Clinical Pastoral Care, University Hospital of Gießen, Giessen, Germany
| | - Matthias Brumhard
- Ethics Delegate, Medical Management, University Hospital of Gießen, Giessen, Germany
| | | | | | - Thomas Heinemann
- Chair of Ethics, Theory and History of Medicine, Philosophical-Theological University of Vallendar, Vallendar, Germany
| | - Ulrika Kilian
- Department of History and Cultural Studies, Giessen, Germany
| | - Yasar Sarikaya
- Department of History and Cultural Studies, Giessen, Germany
| | - Hartmut Kress
- Department of Social Ethics, Faculty of Protestant Theology, Bonn University, Bonn, Germany
| | | | - Yasar Bilgin
- Türkisch-Deutsche Gesundheitsstiftung e.V., Giessen, Germany.,Department of Internal Medicine III, Giessen University Hospital, Giessen, Germany
| | - Klaus-Peter Zimmer
- Department of General Pediatrics and Neonatology, Justus-Liebig-University, Giessen, Germany
| | - Harald Ehrhardt
- Department of General Pediatrics and Neonatology, Justus-Liebig-University, Giessen, Germany
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Kurata H, Ochiai M, Inoue H, Ichiyama M, Yasuoka K, Fujiyoshi J, Matsushita Y, Honjo S, Sakai Y, Ohga S. A nationwide survey on tracheostomy for very-low-birth-weight infants in Japan. Pediatr Pulmonol 2019; 54:53-60. [PMID: 30525314 DOI: 10.1002/ppul.24200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 10/12/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Tracheostomy is indicated for very-low-birth-weight infants (VLBWIs) with prolonged respiratory problems during the perinatal period. The objective of this study is to clarify the epidemiology and risk factors in VLBWIs with tracheostomy after birth in Japan. METHODS A total of 40 806 VLBWIs were registered in the Neonatal Research Network of Japan database from 2003 to 2012. Among them, 34 674 infants (85%) survived over 28 days after birth and were subjected to this study. The clinical variables at birth, outcomes at hospital discharge and associated factors for tracheostomy were examined. RESULTS The proportion of VLBWIs with tracheostomy did not increase during the study period (mean 36 cases per year, 0.93%). The rate of in-hospital death over 28 days after birth did not differ between tracheostomized and non-tracheostomized infants (2/324, 0.6% vs 314/34 350, 0.9%). Tracheostomized infants more frequently had severe or moderate bronchopulmonary dysplasia (BPD) (75.5% vs 26.0%, P < 0.01) and longer hospitalization (229 days vs 83 days, P < 0.01) than non-tracheostomized infants. Tracheostomized patients showed higher comorbidities with hypoxic ischemic encephalopathy (odds ratio [OR] 10.98, P < 0.01), muscular disease (OR 10.95, P < 0.01), severe or moderate BPD (OR 7.79, P < 0.01), chromosomal abnormality (OR 4.43, P < 0.01) or sepsis (OR 1.78, P < 0.05) at hospital discharge than non-tracheostomized patients. CONCLUSION We demonstrated the non-increasing rate in tracheostomy for VLBWIs and such cases were associated with an excellent survival in Japan. These data provide evidence that more attentive care must be practiced in order to reduce the pulmonary and neuromuscular burdens of VLBWIs at birth.
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Affiliation(s)
- Hiroaki Kurata
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan
| | - Masayuki Ochiai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan
| | - Hirosuke Inoue
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan
| | - Masako Ichiyama
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan
| | - Kazuaki Yasuoka
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan
| | - Junko Fujiyoshi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan
| | - Yuki Matsushita
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan
| | - Satoshi Honjo
- Department of Pediatrics, National Hospital Organization Fukuoka Hospital, Fukuoka, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Diguisto C, Foix L'Helias L, Morgan AS, Ancel PY, Kayem G, Kaminski M, Perrotin F, Khoshnood B, Goffinet F. Neonatal Outcomes in Extremely Preterm Newborns Admitted to Intensive Care after No Active Antenatal Management: A Population-Based Cohort Study. J Pediatr 2018; 203:150-155. [PMID: 30270165 DOI: 10.1016/j.jpeds.2018.07.072] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/06/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate the association between active antenatal management and neonatal outcomes in extremely preterm newborns admitted to a neonatal intensive care unit (NICU). STUDY DESIGN This population-based cohort study was conducted in 25 regions of France. Infants born in 2011 between 220/7 and 266/7 weeks of gestation and admitted to a NICU were included. Infants with lethal congenital malformations or death in the delivery room were excluded. A multilevel multivariable analysis was performed, accounting for clustering by mother (multiple pregnancies) and hospital plus individual characteristics, to estimate the association between the main exposure of no active antenatal management (not receiving antenatal corticosteroids, magnesium sulfate, or cesarean delivery for fetal indications) and a composite outcome of death or severe neonatal morbidity (including severe forms of brain or lung injury, retinopathy of prematurity, and necrotizing enterocolitis). RESULTS Among 3046 extremely preterm births, 783 infants were admitted to a NICU. Of these, 138 (18%) did not receive active antenatal management. The risk of death or severe morbidity was significantly higher for infants without active antenatal management (crude OR, 2.60; 95% CI, 1.44-4.66). This finding persisted after adjustment for gestational age (OR, 2.08; 95% CI, 1.19-3.62) and all confounding factors (OR, 1.86; 95% CI, 1.09-3.20). CONCLUSIONS The increased risk of severe neonatal outcomes for extremely preterm babies admitted to a NICU without optimal antenatal management should be considered in individual-level decision making and in the development of professional guidelines for the management of extremely preterm births.
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Affiliation(s)
- Caroline Diguisto
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; Maternité Olympe de Gouges, Regional Univeristy Hospital, François Rabelais University, Tours, France.
| | - Laurence Foix L'Helias
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; Service de Néonatologie Hopital Armand Trousseau, APHP, Pierre et Marie Curie University, Paris, France
| | - Andrei S Morgan
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; Institute for Women's Health, University College London, London, United Kingdom
| | - Pierre-Yves Ancel
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; URC CIC P1419, DHU Risk in Pregnancy, Cochin Hotel Dieu Hopital APHP, Paris, France
| | - Gilles Kayem
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; Service de Gynécologie Obstétrique, Trousseau, APHP, Pierre et Marie Curie University, Paris, France
| | - Monique Kaminski
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Franck Perrotin
- Maternité Olympe de Gouges, Regional Univeristy Hospital, François Rabelais University, Tours, France
| | - Babak Khoshnood
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Francois Goffinet
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; Maternity Unit of Port Royal, Paris Descartes University, Cochin Broca Hotel Dieu Hospitals, DHU Risk in Pregnancy, Cochin Hotel Dieu University Hospital, Assistance Publique des Hopitaux de Paris, Paris, France
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Nakanishi H, Suenaga H, Uchiyama A, Kusuda S. Persistent pulmonary hypertension of the newborn in extremely preterm infants: a Japanese cohort study. Arch Dis Child Fetal Neonatal Ed 2018; 103:F554-F561. [PMID: 29298856 DOI: 10.1136/archdischild-2017-313778] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/14/2017] [Accepted: 11/19/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the characteristics of persistent pulmonary hypertension of the newborn (PPHN) in extremely preterm infants and its impact on neurodevelopmental outcomes at 3 years of age. DESIGN A retrospective multicentre cohort study. SETTINGS 202 tertiary perinatal centres registered in the Neonatal Research Network of Japan (NRNJ). PATIENTS Infants born at <28 weeks of gestational age (GA), between 2003 and 2012, were extracted from tertiary perinatal centres participating in NRNJ. MAIN OUTCOME MEASURES Demographic characteristics, morbidity, interventions and mortality were compared for infants with and without PPHN. Multivariable logistic analysis was performed to evaluate the impact of PPHN on long-term neurodevelopmental outcomes (the prevalence rate of cerebral palsy, need for home oxygen therapy, and visual, hearing and cognitive impairment) at 3 years of age. RESULTS The prevalence of PPHN among the 12 954 extremely preterm infants enrolled was 8.1% (95% CI 7.7% to 8.6%), with the trend increasing annually, and a higher proportion as GA decreased: 18.5% (range, 15.2% to 22.4%) for infants born at 22 weeks compared with 4.4% (range, 3.8% to 5.2%) for those born at 27 weeks. Clinical chorioamnionitis and premature rupture of membranes were associated with PPHN. On multivariate analysis of the data from 5923 infants followed up for 3 years, PPHN was a significant independent risk factor for visual impairment (adjusted OR, 1.42, 95% CI 1.03 to 1.97). CONCLUSIONS The prevalence of PPHN in extremely preterm infants has been increasing over the past decade in Japan. Clinicians should be aware of visual impairments as a neurodevelopmental abnormality among infants with PPHN.
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Affiliation(s)
- Hidehiko Nakanishi
- Maternal and Perinatal Center, Tokyo Women's Medical University, Shinjuku-ku, Japan
| | - Hideyo Suenaga
- Maternal and Perinatal Center, Tokyo Women's Medical University, Shinjuku-ku, Japan
| | - Atsushi Uchiyama
- Maternal and Perinatal Center, Tokyo Women's Medical University, Shinjuku-ku, Japan
| | - Satoshi Kusuda
- Maternal and Perinatal Center, Tokyo Women's Medical University, Shinjuku-ku, Japan
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Esaki M, Maseki Y, Tezuka A, Furuhashi M. Continuous amnioinfusion in women with PPROM at periviable gestational ages. J Matern Fetal Neonatal Med 2018; 33:1151-1156. [PMID: 30149736 DOI: 10.1080/14767058.2018.1517307] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective: To elucidate the efficacy of continuous amnioinfusion on perinatal outcome in women with preterm premature rupture of membranes (PPROM) at periviable gestational ages.Methods: A database was reviewed to identify women with singleton pregnancies who were admitted to the Japanese Red Cross Nagoya Daiichi Hospital due to PPROM before 26 + 0-week gestation between July 2009 and July 2017.Results: A total of 81 women met the criteria for inclusion in this study including 70 and 11 women with and without amnioinfusion, respectively. The latency period between PPROM and delivery was significantly longer in women who underwent amnioinfusion compared with women without amnioinfusion (median: 13 versus 4 days, p < .001). In the survival analysis, the number of women who remained undelivered was significantly higher in the amnioinfusion group than in the non-amnioinfusion group for each gestational age after PPROM (p < .001). Cox's proportional hazards analysis with stepwise backward selection showed that both white blood cell counts on admission and amnioinfusion finally remained as variables that affected the time interval between PPROM and delivery [hazard ratio (95% confidence interval): 1.12 (1.06-1.18) and 0.34 (0.12-0.98), respectively].Conclusions: Continuous amnioinfusion in women with PPROM at periviable gestational ages resulted in significant prolongation of pregnancy and may help improve neonatal outcomes.
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Affiliation(s)
- Masatoshi Esaki
- Department of Obstetrics and Gynecology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Yoshiaki Maseki
- Department of Obstetrics and Gynecology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Atsuko Tezuka
- Department of Obstetrics and Gynecology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
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48
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Verhagen AAE. Why Do Neonatologists in Scandinavian Countries and the Netherlands Make Life-and-death Decisions So Different? Pediatrics 2018; 142:S585-S589. [PMID: 30171145 DOI: 10.1542/peds.2018-0478j] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2018] [Indexed: 11/24/2022] Open
Abstract
An examination of the policies regarding the care of extremely premature newborns reveals unexpected differences between Scandinavian countries and the Netherlands. Three topics related to decision-making at the beginning and at the end of life are identified and discussed.
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Affiliation(s)
- A A Eduard Verhagen
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Forner O, Schiby A, Ridley A, Thiriez G, Mugabo I, Morel V, Mulin B, Filiatre JC, Riethmuller D, Levy G, Semama D, Martin D, Chantegret C, Bert S, Godoy F, Sagot P, Rousseau T, Burguet A. Extremely premature infants: How does death in the delivery room influence mortality rates in two level 3 centers in France? Arch Pediatr 2018; 25:383-388. [PMID: 30041886 DOI: 10.1016/j.arcped.2018.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/27/2018] [Accepted: 06/20/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Mortality rates of very preterm infants may vary considerably between healthcare facilities depending on the neonates' place of inclusion in the cohort study. The objective of this study was to compare the mortality rates of live-born extremely preterm neonates observed in two French tertiary referral hospitals, taking into account the occurrence of neonatal death both in the delivery room and in the neonatal intensive care unit (NICU). METHODS Retrospective observational study including all pregnancy terminations, stillbirths and live-born infants within a 22- to 26-week 0/6 gestational age range was registered by two French level 3 university centers between 2009 and 2013. The mortality rates were compared between the two centers according to two places of inclusion: either the delivery room or the NICU. RESULTS A total of 344 infants were born at center A and 160 infants were born at center B. Among the live-born neonates, the rates of neonatal death were similar in center A (54/125, 43.2%) and center B (33/69, 47.8%; P=0.54). However, neonatal death occurred significantly more often in the delivery room at center A (31/54, 57.4%) than at center B (6/33, 18.2%; P<0.001). Finally, the neonatal death rate of live-born very preterm neonates admitted to the NICU was significantly lower in center A (25/94, 26.6%) than in center B (27/63, 42.9%; P=0.03). CONCLUSIONS This study points out how the inclusion of deaths in the delivery room when comparing neonatal death rates can lead to a substantial bias in benchmarking studies. Center A and center B each endorsed one of the two models of preferential place of neonatal death (delivery room or NICU) detailed in European studies. The reasons behind the two different models and their impact on how parents perceive supporting their neonate need further investigation.
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Affiliation(s)
- O Forner
- Service maternité-obstétrique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France.
| | - A Schiby
- Service réanimation néonatale et pédiatrique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - A Ridley
- Service médecine pédiatrique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - G Thiriez
- Service réanimation néonatale et pédiatrique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - I Mugabo
- Service maternité-obstétrique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - V Morel
- Service réanimation néonatale et pédiatrique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - B Mulin
- Réseau périnatalité de Franche-Comté, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - J-C Filiatre
- Réseau périnatalité de Franche-Comté, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - D Riethmuller
- Service gynécologie obstétrique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - G Levy
- Service gynécologie obstétrique, hôpital Nord Franche-Comté, 100, route de Moval, 90400 Trevenans, France
| | - D Semama
- Service réanimation néonatale et pédiatrique, hôpital d'enfants, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - D Martin
- Service réanimation néonatale et pédiatrique, hôpital d'enfants, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - C Chantegret
- Service réanimation néonatale et pédiatrique, hôpital d'enfants, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - S Bert
- Service maternité obstétrique, hôpital d'enfants, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - F Godoy
- Service réanimation néonatale et pédiatrique, hôpital d'enfants, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - P Sagot
- Service gynécologie obstétrique, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - T Rousseau
- Service gynécologie obstétrique, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - A Burguet
- Service réanimation néonatale et pédiatrique, hôpital d'enfants, 14, rue Paul-Gaffarel, 21000 Dijon, France
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Trends in the neurodevelopmental outcomes among preterm infants from 2003-2012: a retrospective cohort study in Japan. J Perinatol 2018; 38:917-928. [PMID: 29679045 DOI: 10.1038/s41372-018-0061-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/10/2017] [Accepted: 01/22/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To determine the trends in mortality and the prevalence of abnormal neurodevelopmental outcomes among preterm Japanese infants. STUDY DESIGN A retrospective multicenter cohort of 30,793 preterm infants born at a gestational age ≤32 weeks, between 2003 and 2012, in the Neonatal Research Network, Japan, was evaluated in the primary analysis. Finally, 13,661 infants were followed-up until 3 years of age and evaluated for neurodevelopmental outcomes, including cerebral palsy (CP), home oxygen therapy (HOT) use, and visual, hearing, and cognitive impairments. Multivariable logistic regression analysis was performed to determine the risk-adjusted trends in mortality and long-term neurodevelopmental outcomes. RESULTS The trends in overall mortality (adjusted odds ratio, (AOR): 0.92; 95% confidence interval, (CI): 0.89-0.94), the prevalence of CP (AOR: 0.95, 95% CI: 0.92-0.98), HOT use (AOR: 0.84, 95% CI: 0.75-0.93), and visual (AOR: 0.84, 95% CI: 0.81-0.87) and hearing impairments (AOR: 0.78, 95% CI: 0.63-0.97) showed a significant downward trend, while cognitive impairment showed no significant changes (AOR: 1.02, 95% CI: 0.99-1.05). Intravenous hyperalimentation was significantly correlated with visual impairment (AOR 0.74, 95% CI 0.59-0.91). Early establishment of enteral feeding was associated with improved long-term outcomes. CONCLUSIONS Mortality was improved, and this did not lead to increased risks for abnormal neurodevelopmental outcomes. Nutritional support might improve long-term neurodevelopmental outcomes.
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