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Cerovac A, Nevačinović E, Habek D, Laganà AS, Chiantera V, Naem A, Čehić E, Halilović R, Cerovac E, Zulović T. Capabilities of perinatal healthcare institutions in primary and tertiary care of low birth weight infants in the Federation of Bosnia and Herzegovina: a cross-sectional multicentric study. Ann Med Surg (Lond) 2024; 86:768-772. [PMID: 38333265 PMCID: PMC10849373 DOI: 10.1097/ms9.0000000000001634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/08/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction Providing adequate healthcare for premature infants is an important issue in perinatal medicine. The aim of this study is to assess the level of the perinatal healthcare institution (PHI) where the newborns were delivered and the possibilities of transporting them to the cantons of the Federation of Bosnia and Herzegovina. The authors also aimed to examine the overall survival of low birth-weight infants (LBWI) in the Federation of Bosnia and Herzegovina and to compare the survival of newborns according to the PHI where they were born and the PHI where they were treated. Materials and methods This cross-sectional study included newborns of both sexes that were born in the maternity wards in 10 cantons of the Federation of Bosnia and Herzegovina with a gestational age between 22 and 42 weeks, and a birth weight less than 2500 g. Result From the PHI of the first and second level, 159 newborns were referred to the third level. A total of 159/669 (23.7%) were referred from a second level PHI to a third level PHI, and 127/669 (l8.9%) LBWI were definitely taken care of. A total of 513/669 (76.8%) LBWI were definitely taken care of in the third level PHI. Out of a total of 159 LBWI referred from other PHI, only 31 (19.5%) LBWI were transported in less than 4 h, and 128 (80.5%) newborns were admitted to the third level PHI within 4 h of birth (P<0.0001). In second level PHI, most LBWI died in the first 12 h after birth, while in third level PHI, 69.2% of LBWI died after 1 week of life. Conclusion Based on world experience and assessment of the situation in Federation of Bosnia and Herzegovina, it is necessary to take measures to improve perinatal care and its regional organization.
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Affiliation(s)
- Anis Cerovac
- Department of Gynecology and Obstetrics
- School of Medicine, University of Tuzla, Tuzla
| | - Enida Nevačinović
- Clinic for Gynecology and Obstetrics, University Clinical Centre Tuzla
| | - Dubravko Habek
- School of Medicine, Croatian Catholic University Zagreb, Zagreb, Croatia
| | - Antonio Simone Laganà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, Palermo, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione “G. Pascale”, Naples
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Antoine Naem
- Faculty of Medicine of Damascus University, Damascus, Syrian Arab Republic
| | - Ermin Čehić
- Department of Obstetrics and Gynecology, Human reproduction Unit, Cantonal Hospital Zenica
- University of Zenica, School of Medicine
| | | | - Elmedina Cerovac
- Department of Anesthesiology, Reanimatology and Intensive Care, General Hospital Tešanj, Tešanj
- School of Medicine, University of Tuzla, Tuzla
| | - Tarik Zulović
- Department of Obstetrics and Gynecology, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
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Winter EL, Caemmerer JM, Trudel SM, deLeyer-Tiarks J, Bray MA, Dale BA, Kaufman AS. Does the Degree of Prematurity Relate to the Bayley-4 Scores Earned by Matched Samples of Infants and Toddlers across the Cognitive, Language, and Motor Domains? J Intell 2023; 11:213. [PMID: 37998712 PMCID: PMC10671985 DOI: 10.3390/jintelligence11110213] [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: 04/27/2023] [Revised: 09/30/2023] [Accepted: 11/03/2023] [Indexed: 11/25/2023] Open
Abstract
The literature on children born prematurely has consistently shown that full-term babies outperform preterm babies by about 12 IQ points, even when tested as adolescents, and this advantage for full-term infants extends to the language and motor domains as well. The results of comprehensive meta-analyses suggest that the degree of prematurity greatly influences later test performance, but these inferences are based on data from an array of separate studies with no control of potential confounding variables such as age. This study analyzed Bayley-4 data for 66 extremely premature infants and toddlers (<32 weeks), 70 moderately premature children (32-36 weeks), and 133 full-term children. All groups were carefully matched on key background variables by the test publisher during the standardization of the Bayley-4. This investigation analyzed data on the five subtests: cognitive, expressive communication, receptive communication, fine motor, and gross motor. A multivariate analysis of covariance (MANCOVA) assessed for group mean differences across the three subsamples, while controlling for the children's age. Extremely premature children scored significantly lower than moderately premature children on all subtests, and both preterm groups were significantly outscored by the full-term sample across all domains. In each set of comparisons, the cognitive and motor subtests yielded the largest differences, whereas language development, both expressive and receptive, appeared the least impacted by prematurity. A follow-up MANOVA was conducted to examine full-term versus preterm discrepancies on the five subtests for infants (2-17 months) vs. toddlers (18-42 months). For that analysis, the two preterm groups were combined into a single preterm sample, and a significant interaction between the age level and group (full-term vs. preterm) was found. Premature infants scored lower than premature toddlers on receptive communication, fine motor, and cognitive. Neither expressive communication nor gross motor produced significant discrepancies between age groups The findings of this study enrich the preterm literature on the degree of prematurity; the age-based interactions have implications for which abilities are most likely to improve as infants grow into toddlerhood.
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Affiliation(s)
- Emily L Winter
- School of Health Sciences Clinical PsyD Program, Touro University, New York, NY 10036, USA
| | | | - Sierra M Trudel
- Department of Occupational and Environmental Medicine, University of Connecticut School of Medicine, Farmington, CT 06030, USA
| | | | - Melissa A Bray
- Department of Educational Psychology, University of Connecticut, Storrs, CT 06268, USA
| | - Brittany A Dale
- Department of Special Education, Ball State University, Muncie, IN 47306, USA
| | - Alan S Kaufman
- Department of Educational Psychology, University of Connecticut, Storrs, CT 06268, USA
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Adler-Haltovsky T, Gileles-Hillel A, Erlichman I, Eventov-Friedman S. Changes in ventilation modes in the last decade and their impact on the prevalence of bronchopulmonary dysplasia in preterm infants. Pediatr Pulmonol 2023. [PMID: 37083198 DOI: 10.1002/ppul.26418] [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: 12/25/2022] [Revised: 03/08/2023] [Accepted: 04/07/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Less invasive forms of ventilation have evolved aiming to decrease bronchopulmonary dysplasia (BPD) morbidity. It is unclear whether changes in ventilation practices have been associated with improvements in respiratory outcomes. OBJECTIVE To examine the changes in ventilation modes in preterm neonates between two periods during the last decade and their impact on BPD prevalence. METHODS A retrospective chart review of very low birth weight infants and those born at less than 32 weeks gestation hospitalized during two periods: the years 2012-2013 and 2018-2019. The primary outcome was the prevalence of BPD. Study variables included the mode and duration of ventilation, duration of oxygen need, and perinatal clinical parameters. RESULTS Four hundred eighty-one infants were enrolled. Between the two study periods, a significant increase was observed in invasive (33%-47%, p = 0.002), and noninvasive ventilation rates (44%-72%, p < 0.001). The average duration of noninvasive ventilation increased significantly (from 9.24 to 14.08 days, p = 0.016). The total duration of respiratory support remained unchanged. The overall prevalence of moderate and severe BPD at 36 weeks corrected age remained approximately 40% in preterm infants born at less than 28 weeks gestation. CONCLUSION The increasing use of non-invasive ventilation was not accompanied by a reduction in the use of invasive ventilation, nor by a reduced prevalence of BPD. The high prevalence of BPD remains a significant problem in extreme prematurity. Other interventions, in addition to less aggressive ventilation, need to be explored.
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Affiliation(s)
| | - Alex Gileles-Hillel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Pediatric Pulmonology Unit, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Ira Erlichman
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Neonatology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Smadar Eventov-Friedman
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Neonatology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
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Neuromotor Development Evaluation of Preterm Babies Less than 34 Weeks of Gestation with Bayley III at 18-24 Months. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5480450. [PMID: 33145354 PMCID: PMC7596459 DOI: 10.1155/2020/5480450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/16/2020] [Accepted: 10/15/2020] [Indexed: 11/17/2022]
Abstract
Objectives To assess and evaluate the risk factors affecting the neuromotor development of preterm babies at corrected age 18 to 24 months. Methods Preterm babies ≤ 34 weeks of gestational age (GA) who were born in our hospital between 2011 and 2014 were prospectively included in the study. Prenatal, perinatal, and postnatal features of the babies were recorded. Bayley Scales of Infants and Toddler Development, Third Edition (Bayley-III), was applied at corrected age 18 to 24 months. Results All data of 96 babies were obtained during the study, mean birth weight was 1542 ± 518 g, and mean corrected age was 20.9 ± 4.7 months. Cerebral palsy was found in 11 babies (11.5%). According to Bayley III scores, 13.5% cognitive delay, 19.8% language delay, and 33.3% motor delay rations were detected. A positive correlation was found between GA and motor composite scores (p = 0.011). The mean motor composite score was lower in babies with the Apgar score less than 7 at 1st and 5th minutes (p = 0.007 and p = 0.003) and applied resuscitation in the delivery room (p = 0.033). The mean language composite score was found to be higher in babies with antenatal steroid administration (p = 0.003). A negative correlation was found between the motor composite score and the oxygen treatment time and mechanical ventilation support time (p = 0.001 and p = 0.007). Conclusion In preterm babies less than 34 weeks, the birth weight, GA, Apgar score, oxygen treatment time, mechanical ventilation support time, and resuscitation in a delivery room were determined to affect the Bayley III motor score. Language development was found better in babies with antenatal steroid administration.
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Ireland S, Larkins S, Ray R, Woodward L. Negativity about the outcomes of extreme prematurity a persistent problem - a survey of health care professionals across the North Queensland region. Matern Health Neonatol Perinatol 2020; 6:2. [PMID: 32368347 PMCID: PMC7189572 DOI: 10.1186/s40748-020-00116-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background Extremely preterm babies are at risk of significant mortality and morbidity due to their physiological immaturity. At periviable gestations decisions may be made to either provide resuscitation and intensive care or palliation based on assessment of the outlook for the baby and the parental preferences. Health care professionals (HCP) who counsel parents will influence decision making depending on their individual perceptions of the outcome for the baby. This paper aims to explore the knowledge and attitudes towards extremely preterm babies of HCP who care for women in pregnancy in a tertiary, regional and remote setting in North Queensland. Methods A cross sectional electronic survey of HCP was performed. Perceptions of survival, severe disability and intact survival data were collected for each gestational age from 22 to 27 completed weeks gestation. Free text comment enabled qualitative content analysis. Results Almost all 113 HCP participants were more pessimistic than the actual outcome data suggests. HCP caring for women antenatally were the most pessimistic for survival (p = 0.03 at 23 weeks, p = 0.02 at 25,26 and 27 weeks), severe disability (p = 0.01 at 24 weeks) and healthy outcomes (p = 0.01 at 24 weeks), whilst those working in regional and remote centres were more negative than those in tertiary unit for survival (p = 0.03 at 23,24,25 weeks). Perception became less negative as gestational age increased. Conclusion Pessimism of HCP may be negatively influencing decision making and will negatively affect the way in which parents perceive the chances of a healthy outcome for their offspring.
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Affiliation(s)
- Susan Ireland
- The neonatal unit, Townsville University Hospital, Angus Smith Drive, Douglas, Queensland 4814 Australia.,2Department Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Sarah Larkins
- 2Department Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Robin Ray
- 2Department Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Lynn Woodward
- 2Department Medicine and Dentistry, James Cook University, Townsville, Australia
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Godeluck A, Gérardin P, Lenclume V, Mussard C, Robillard PY, Sampériz S, Benhammou V, Truffert P, Ancel PY, Ramful D. Mortality and severe morbidity of very preterm infants: comparison of two French cohort studies. BMC Pediatr 2019; 19:360. [PMID: 31623604 PMCID: PMC6796444 DOI: 10.1186/s12887-019-1700-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/29/2019] [Indexed: 01/28/2023] Open
Abstract
Background In Reunion Island, a French overseas department, the burden of preterm birth and perinatal mortality exceed those observed in mainland France, despite similar access to standard perinatal care. The purpose of the study was to compare the outcome of two cohorts of NICU-admitted very preterm infants born between 24 and 31 weeks of gestation (WG): the registry-based OGP (Observatoire de la Grande Prématurité, Reunion Island, 2008–2013) cohort, and the nationwide EPIPAGE-2 (mainland France, 2011) observational cohort. Methods The primary outcome was adverse neonatal outcomes defined as a composite indicator of in-hospital mortality or any of three following severe morbidities: bronchopulmonary dysplasia (BPD), necrotising enterocolitis, or severe neurological injury (periventricular leukomalacia or grade III-IV intraventricular haemorrhages). Logistic regression modelling adjusting for confounders was performed. Results A total of 1272 very preterm infants from the Reunionese OGP cohort and 3669 peers from the mainland EPIPAGE-2 cohort were compared. Adverse neonatal outcomes were more likely observed in the OGP cohort (32.6% versus 26.6%, p < 0.001), as result of both increased in-hospital mortality across all gestational age strata and increased BPD among the survivors of the 29–31 WG stratum. After adjusting for gestational age, gender and multiple perinatal factors, the risk of adverse neonatal outcomes was higher in the OGP cohort than in the EPIPAGE-2 cohort across all gestational age strata. Conclusions Despite similar guidelines for standard perinatal care, very preterm infants born in Reunion Island have a higher risk for death or severe morbidity compared with those born in mainland France. Electronic supplementary material The online version of this article (10.1186/s12887-019-1700-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Patrick Gérardin
- INSERM CIC1410 Epidémiologie Clinique, CHU de la Réunion, Saint Pierre, Réunion
| | - Victorine Lenclume
- INSERM CIC1410 Epidémiologie Clinique, CHU de la Réunion, Saint Pierre, Réunion
| | - Corinne Mussard
- INSERM CIC1410 Epidémiologie Clinique, CHU de la Réunion, Saint Pierre, Réunion
| | - Pierre-Yves Robillard
- CHU de la Réunion, Saint Pierre, Réunion.,Centre d'Etudes Périnatales de l'Océan Indien (CEPOI), Université de la Réunion, EA 7388, Saint-Denis, France
| | | | | | - Patrick Truffert
- CHU Lille, EA 2694 Public Health, Epidemiology and Quality of Care unit, F-59000, Lille, France
| | - Pierre-Yves Ancel
- INSERM U 1153, CHU Cochin Hôtel Dieu, Paris, France.,Université Paris Descartes, Paris, France.,URC - CIC1419 Plurithématique, Cochin Hôtel Dieu, Paris, France
| | - Duksha Ramful
- CHU de la Réunion, Saint Denis, Réunion. .,INSERM CIC1410 Epidémiologie Clinique, CHU de la Réunion, Saint Pierre, Réunion. .,Postal address: Neonatal and pediatric intensive care unit, Félix Guyon Hospital, CHU de La Réunion, Allée des Topazes, CS 11021, 97400, Saint-Denis Cedex, La Réunion, France.
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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: 94] [Impact Index Per Article: 18.8] [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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Berry MJ, Foster T, Rowe K, Robertson O, Robson B, Pierse N. Gestational Age, Health, and Educational Outcomes in Adolescents. Pediatrics 2018; 142:peds.2018-1016. [PMID: 30381471 DOI: 10.1542/peds.2018-1016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES As outcomes for extremely premature infants improve, up-to-date, large-scale studies are needed to provide accurate, contemporary information for clinicians, families, and policy makers. We used nationwide New Zealand data to explore the impact of gestational age on health and educational outcomes through to adolescence. METHODS We performed a retrospective cohort study of all births in New Zealand appearing in 2 independent national data sets at 23 weeks' gestation or more. We report on 2 separate cohorts: cohort 1, born January 1, 2005 to December 31, 2015 (613 521 individuals), used to study survival and midterm health and educational outcomes; and cohort 2, born January 1, 1998 to December 31, 2000, and surviving to age 15 years (146 169 individuals), used to study high school educational outcomes. Outcomes described by gestational age include survival, hospitalization rates, national well-being assessment outcomes at age 4 years, rates of special education support needs in primary school, and national high school examination results. RESULTS Ten-year survival increased with gestational age from 66% at 23 to 24 weeks to >99% at term. All outcomes measured were strongly related to gestational age. However, most extremely preterm children did not require special educational support and were able to sit for their national high school examinations. CONCLUSIONS Within a publicly funded health system, high-quality survival is achievable for most infants born at periviable gestations. Outcomes show improvement with gestational ages to term. Outcomes at early-term gestation are poorer than for children born at full term.
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Affiliation(s)
- Mary J Berry
- Departments of Paediatrics and Child Health and .,Capital and Coast District Health Board, Wellington, New Zealand; and
| | - Tim Foster
- Public Health, University of Otago, Wellington, Wellington, New Zealand.,Hawke's Bay District Health Board, Napier, New Zealand
| | - Kate Rowe
- Capital and Coast District Health Board, Wellington, New Zealand; and
| | - Oliver Robertson
- Public Health, University of Otago, Wellington, Wellington, New Zealand
| | - Bridget Robson
- Public Health, University of Otago, Wellington, Wellington, New Zealand
| | - Nevil Pierse
- Public Health, University of Otago, Wellington, Wellington, New Zealand
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Lee M, Pascoe JM, McNicholas CI. Reading, Mathematics and Fine Motor Skills at 5 Years of Age in US Children who were Extremely Premature at Birth. Matern Child Health J 2018; 21:199-207. [PMID: 27423237 DOI: 10.1007/s10995-016-2109-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives The prevalence of extreme prematurity at birth has increased, but little research has examined its impact on developmental outcomes in large representative samples within the United States. This study examined the association of extreme prematurity with kindergarteners' reading skills, mathematics skills and fine motor skills. Methods The early childhood longitudinal study-birth cohort, a representative sample of the US children born in 2001 was analyzed for this study. Early reading and mathematics skills and fine motor skills were compared among 200 extremely premature children (EPC) (gestational age <28 wks or birthweight <1000 g), 500 premature children (PC), and 4300 term children (TC) (≥37wks or ≥2500 g). Generalized linear regression analyses included sampling weights, children's age, race, sex, and general health status, and parental marital status and education among singleton children. Results At age 5 years, EPC were 2.6(95 % CI 1.7-3.8) times more likely to fail build a gate and were 3.1(95 % CI 1.6-5.8) times more likely to fail all four drawing tasks compared to TC (p values <0.001). Fine motor performance of PC (failed to build a gate, 1.3[95 % CI 1.0-1.7]; failed to draw all four shapes, 1.1[95 % CI 0.8-1.6]) was not significantly different from TC. Mean early reading scale score (36.8[SE:1.3]) of EPC was 4.0 points lower than TC (p value < 0.0001) while mean reading score (39.9[SE:1.4]) of PC was not significantly different from TC (40.8[SE:1.1]). Mean mathematics scale score were significantly lower for both EPC (35.5[SE:1.0], p value < 0.001) and PC (39.8[SE:0.8], p value = 0.023) compared to TC (41.0[SE:0.6]). Conclusions for Practice Extreme prematurity at birth was associated with cognitive and fine motor delays at age 5 years. This suggests that based on a nationally representative sample of infants, the biological risk of extreme prematurity persists after adjusting for other factors related to development.
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Affiliation(s)
- Miryoung Lee
- Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA. .,Department of Community Health, Lifespan Health Research Center, Boonshoft School of Medicine, Wright State University, 3171 Research Blvd, Dayton, OH, 45420, USA.
| | - John M Pascoe
- Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Caroline I McNicholas
- Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
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10
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Constructing a relevant decision aid for parents of children with bronchopulmonary dysplasia. J Perinatol 2017; 37:1341-1345. [PMID: 29048414 DOI: 10.1038/jp.2017.141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/10/2017] [Accepted: 05/15/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND To develop and test a decision aid for counseling parents of children with bronchopulmonary dysplasia (BPD).Local problem:Parental education about complex conditions is not standardized and communication and understanding may not be adequate. METHODS Semi-structured interviews were conducted with 33 neonatal clinicians and 12 parents of children with BPD using a qualitative research design. The interviews were used to identify education topics that were felt to be important in BPD education. These topics were then used to create a visual decision aid to be used in counseling sessions with parents. The decision aid was then used in mock counseling sessions with 15 'experienced' participants and 7 'naïve' participants to assess its efficacy. The participants completed a pre and post test to assess change in knowledge as well as an 11-question Likert style acceptability survey. INTERVENTION Implementation of a decision aid while educating parents about BPD. RESULTS Topics identified during the interviews were used to create eight educational cards which included pictures, pictographs and statistics. Overall, participants thought the decision aid contained an appropriate amount of information, were easy to understand and improved their knowledge about BPD. Testing demonstrated a significant increase in knowledge in both the 'experienced' (P<0.0001) and 'naïve' group (P=0.0064). CONCLUSION A decision aid for parents of children with BPD may improve understanding of the condition and help facilitate communication between parents and doctors.
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11
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Berry MJ, Saito-Benz M, Gray C, Dyson RM, Dellabarca P, Ebmeier S, Foley D, Elder DE, Richardson VF. Outcomes of 23- and 24-weeks gestation infants in Wellington, New Zealand: A single centre experience. Sci Rep 2017; 7:12769. [PMID: 28986579 PMCID: PMC5630631 DOI: 10.1038/s41598-017-12911-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 09/12/2017] [Indexed: 11/21/2022] Open
Abstract
Optimal perinatal care of infants born less than 24 weeks gestation remains contentious due to uncertainty about the long-term neurodevelopment of resuscitated infants. Our aim was to determine the short-term mortality and major morbidity outcomes from a cohort of inborn infants born at 23 and 24 weeks gestation and to assess if these parameters differed significantly between infants born at 23 vs. 24 weeks gestation. We report survival rates at 2-year follow-up of 22/38 (58%) at 23 weeks gestation and 36/60 (60%) at 24 weeks gestation. Neuroanatomical injury at the time of discharge (IVH ≥ Grade 3 and/or PVL) occurred in in 3/23 (13%) and 1/40 (3%) of surviving 23 and 24 weeks gestation infants respectively. Rates of disability at 2 years corrected postnatal age were not different between infants born at 23 and 24 weeks gestation. We show evidence that with maximal perinatal care in a tertiary setting it is possible to achieve comparable rates of survival free of significant neuroanatomical injury or severe disability at age 2 in infants born at 23-week and 24-weeks gestation.
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Affiliation(s)
- Mary Judith Berry
- Department of Paediatrics & Child Health, University of Otago, Wellington, New Zealand.
- Neonatal Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand.
| | - Maria Saito-Benz
- Department of Paediatrics & Child Health, University of Otago, Wellington, New Zealand
- Neonatal Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand
| | - Clint Gray
- Department of Paediatrics & Child Health, University of Otago, Wellington, New Zealand
| | - Rebecca Maree Dyson
- Department of Paediatrics & Child Health, University of Otago, Wellington, New Zealand
- Graduate School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, New South Wales, Australia
| | - Paula Dellabarca
- Neonatal Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand
| | - Stefan Ebmeier
- The Medical Research Institute of New Zealand, Wellington, New Zealand
| | - David Foley
- Department of Microbiology, Wellington Regional Hospital, Wellington, New Zealand
| | - Dawn Elizabeth Elder
- Department of Paediatrics & Child Health, University of Otago, Wellington, New Zealand
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de Mello RR, Reis ABR, da Silva KS. Cognitive performance of premature infants: association between bronchopulmonary dysplasia and cognitive skills. Cross-sectional study. SAO PAULO MED J 2017; 135:383-390. [PMID: 28767992 PMCID: PMC10016003 DOI: 10.1590/1516-3180.2017.0010190317] [Citation(s) in RCA: 2] [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: 03/16/2017] [Accepted: 03/19/2017] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE: Children born prematurely often have worse cognitive performance than those born at term regarding skills such as memory, attention and processing speed. Bronchopulmonary dysplasia may compromise cognitive development. The aims here were: a) To describe the cognitive performance of preterm infants with very low birth weight; b) To investigate its association with bronchopul-monary dysplasia adjusted for sociodemographic, neonatal and post-neonatal factors. DESIGN AND SETTING: Cross-sectional study developed in a public tertiary-care hospital. METHODS: To evaluate cognition among 112 children, we applied an intelligence scale (Wechsler scale). The average scores for children with and without bronchopulmonary dysplasia were compared across the fve domains of the scale. Associations with bronchopulmonary dysplasia were investigated for domains that showed signifcant diferences between the two groups. Associations between exposure and outcome were estimated via multivariate logistic regression. RESULTS: There were no diferences in averages for the full-scale intelligence quotient, verbal intelligence quotient, performance intelligence quotient and general language composite domains. The processing speed quotient was the only domain that presented a signifcant diference between the two groups (P = 0.02). Among the children with bronchopulmonary dysplasia, low full-scale intelligence quotient was observed in 28.1%. In the multivariate analysis, bronchopulmonary dysplasia (odds ratio: 3.1; 95conf-dence interval: 1.1-8.7) remained associated with the outcome of processing speed quotient. CONCLUSION: Bronchopulmonary dysplasia was an independent risk factor for alteration of the processing speed quotient.
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Affiliation(s)
- Rosane Reis de Mello
- MD, PhD. Attending Physician, Department of Neonatology, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fiocruz, Rio de Janeiro (RJ), Brazil.
| | - Ana Beatriz Rodrigues Reis
- MSc. Clinical Psychologist, Department of Neonatology, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fiocruz, Rio de Janeiro (RJ), Brazil.
| | - Kátia Silveira da Silva
- MD, PhD. Epidemiologist, Clinical Research Unit, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fiocruz, Rio de Janeiro (RJ), Brazil.
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Abstract
The majority of medications in children are administered in an unlicensed or off-label manner. Paediatricians are obliged to prescribe using the limited evidence available. The 2007 EU regulation on the use of paediatric drugs means pharmaceutical companies are now obliged to (and receive incentives for) contributing to paediatric drug data and carrying out paediatric clinical trials. This is important, as the efficacy and adverse effect profiles of medicines vary across childhood. Additionally, there are significant age-related changes in the pharmacodynamic and pharmacokinetic activity of many drugs. This may be related to physiological (differential expressions of cytochrome P450 enzymes or variable glomerular filtration rates at different ages for example) and psychological (increasing autonomy and risk perception in teenage years) changes. Increasing numbers of children are surviving life-threatening childhood conditions due to medical advances. This means there is an increasing population who are at risk of the consequences of the long-term, early exposure to nephrotoxic agents. The kidney is an organ that is particularly vulnerable to damage as a consequence of drugs. Drug-induced acute kidney injury (AKI) episodes in children and babies are principally due to non-steroidal anti-inflammatory drugs, antibiotics or chemotherapeutic agents. The renal tubules are vulnerable to injury because of their concentrating ability and high-energy hypoxic environment. This review focuses on drug-induced AKI and the methods to minimise its effect, including general management plus the role of child-specific pharmacokinetic data, the use of pharmacogenomics and early detection of AKI using urinary biomarkers and electronic triggers.
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Yang C, Liu Z, Tian M, Xu P, Li B, Yang Q, Yang Y. Relationship Between Serum Albumin Levels and Infections in Newborn Late Preterm Infants. Med Sci Monit 2016; 22:92-8. [PMID: 26747243 PMCID: PMC4716710 DOI: 10.12659/msm.895435] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background We aimed to evaluate the clinical value of serum albumin levels for the evaluation and prognosis of late preterm infants with infections. Material/Methods This was a retrospective study performed in late preterm infants admitted at the neonatal intensive care unit (NICU) of the Liaocheng People’s Hospital between July 2012 and March 2013. Data, including laboratory test results, neonatal critical illness score (NCIS), perinatal complications and prognosis, were analyzed. The newborn infants were divided into 3 groups according to their serum albumin levels, (≥30 g/L, 25–30 g/L and ≤25 g/L for high, moderate, and low, respectively). Results Among 257 patients, birth weight was 2003±348 g, gestational age was 35.7±2.3 weeks, and 59.1% were male. In addition, 127 (49.4%) were in the low albumin group. There were 32 patients with sepsis, 190 with infections, and 35 without infection, and their rates of hypoalbuminemia were 86.0%, 50.5%, and 30.7%, respectively (P<0.05). Albumin levels of the patients who survived were higher than those of the patients who died. In the low albumin group, the number of individual-event-critical NCIS cases and the frequency of multiple organs injuries were 63.8% and 28.3%, respectively, and were higher than in the 2 other groups. Mortality was higher in patients with sepsis. Hypoalbuminemia was associated with severe adverse outcomes (odds ratio=6.3, 95% confidence interval: 3.7–10.9, P<0.001). Conclusions Hypoalbuminemia was frequent among neonates with sepsis. Lower albumin levels might be associated with a poorer prognosis. Albumin levels could be appropriate for the diagnosis and prognosis of late preterm neonates with infections.
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Affiliation(s)
- Chunyan Yang
- Department of Peadiatric, Liaocheng People's Hospital, Liaocheng, Shandong, China (mainland)
| | - Zhaoguo Liu
- Department of Peadiatric, Maternity and Child Care, Liaocheng, Shandong, China (mainland)
| | - Min Tian
- Department of Peadiatric, Maternity and Child Care, Dongchangfu, Liaocheng, Shandong, China (mainland)
| | - Ping Xu
- Department of Peadiatric, Liaocheng People's Hospital, Liaocheng, Shandong, China (mainland)
| | - Baoyun Li
- Department of Peadiatric, Liaocheng People's Hospital, Liaocheng, Shandong, China (mainland)
| | - Qiaozhi Yang
- Department of Peadiatric, Liaocheng People's Hospital, Liaocheng, Shandong, China (mainland)
| | - Yujun Yang
- Department of Peadiatric, Liaocheng People's Hospital, Liaocheng, Shandong, China (mainland)
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Perinatal practice in extreme premature delivery: variation in Dutch physicians' preferences despite guideline. Eur J Pediatr 2016; 175:1039-46. [PMID: 27251669 PMCID: PMC4930484 DOI: 10.1007/s00431-016-2741-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/19/2016] [Accepted: 05/25/2016] [Indexed: 11/04/2022]
Abstract
UNLABELLED Decisions at the limits of viability about initiating care are challenging. We aimed to investigate physicians' preferences on treatment decisions, against the background of the 2010 Dutch guideline offering active care from 24(+0/7) weeks of gestational age (GA). Obstetricians' and neonatologists' opinions were compared. An online survey was conducted amongst all perinatal professionals (n = 205) of the 10 Dutch level III perinatal care centers. Response rate was 60 % (n = 122). Comfort care was mostly recommended below 24(+0/7) weeks and intensive care over 26(+0/7) weeks. The professional views varied most at 24 and 25 weeks, with intensive care recommended but comfort care at parental request optional being the median. There was a wide range in perceived lowest limits of GA for interventions as a caesarian section and a neonatologist present at birth. Obstetricians and neonatologists disagreed on the lowest limit providing chest compressions and administering epinephrine for resuscitation. The main factors restricting active treatment were presence of congenital disorders, "small for gestational age" fetus, and incomplete course of corticosteroids. CONCLUSION There was a wide variety in individually preferred treatment decisions, especially when aspects were not covered in the Dutch guideline on perinatal practice in extreme prematurity. Furthermore, obstetricians and neonatologists did not always agree. WHAT IS KNOWN • Cross-cultural differences exists in the preferred treatment at the limits of viability • In the Netherlands since 2010, intensive care can be offered starting at 24 (+0/7) weeks gestation What is new: • There was a wide variety in preferred treatment decisions at the limits of viability especially when aspects were not covered in the Dutch national guideline on perinatal practice in extreme prematurity.
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Predictive validity of the Bayley, Third Edition at 2 years for intelligence quotient at 4 years in preterm infants. J Dev Behav Pediatr 2014; 35:570-5. [PMID: 25370298 DOI: 10.1097/dbp.0000000000000110] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the predictive validity of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) at age 2 years for cognitive abilities in preschool children born at ≤ 30 weeks' gestation. METHODS This prospective regional study included all 187 liveborn infants ≤ 30 weeks' gestation born between July 2005 and June 2006. Of the 172 children who survived to 4 years, 156 (91%) were evaluated at 2 and 4 years. A socioeconomically matched term control group also was recruited to provide normative data. The predictive validity of the Bayley-III cognitive and language scales for the Weschler Preschool and Primary Scale of Intelligence-III (WPPSI-III) was examined through correlation coefficients and sensitivity and specificity of the Bayley-III to predict normal and abnormal cognitive outcomes. RESULTS Correlations of the WPPSI-III intelligence quotient (IQ) score with the Bayley-III cognitive and language scores were .81 and .78, respectively. The preterm children were classified as normal (Bayley Scales of Infant Development-Third Edition [BSID-III] cognitive score or WPPSI-III IQ score not lower than 1 SD below the control group mean), mild to moderately delayed (scores between 1 and 2 SD deviations below the control group mean), or severely delayed (scores greater than 2 SD below the control group mean). At 2 and 4 years, 126 (81%) preterm children retained the same developmental classification. CONCLUSIONS In contrast with previous editions of the BSID, the Bayley-III has strong predictive validity for WPPSI-III IQ at age 4 years in preterm children. This has important implications for more timely evaluation of perinatal interventions, establishment of guidelines for neonatal care, and counseling parents.
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García P, San Feliciano L, Benito F, García R, Guzmán J, Salas S, Fernández C, Del Prado N, Ciprián D, Figueras J. [Outcome at two years corrected age of a cohort of very low birth weight infants from hospitals within the neonatal SEN1500 network]. An Pediatr (Barc) 2013; 79:279-87. [PMID: 23684170 DOI: 10.1016/j.anpedi.2013.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 03/21/2013] [Accepted: 03/22/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To describe growth and neurodevelopmental status of 4,944 children who completed a follow-up at two years of corrected age out of the 10,456 newborns with weight ≤1500g born between the years 2002-2007 and discharged from hospitals within the network SEN1500. A total of 522 newborns were excluded as they had some type of malformation. The total number of children assessed represents the 49.76% of children discharged alive and without malformations. METHODS A retrospective review was conducted using prospectively collected data in the SEN1500 database. We compared growth data at two years of corrected age according to birth weight and sex. Motor impairment, incidence of cerebral palsy, visual and hearing disabilities, and abnormal neurodevelopment for gestational age were analysed between groups. We studied the associations between cerebral palsy (CP) and perinatal factors. RESULTS At 2 years of age 44.2% of children had a weight <2 SD for corrected age. Children with birth weight ≤1000g showed worse outcomes in growth. Some type of motor impairment was observed in 6.96% of the infants, and 4.56% of them were diagnosed with CP. The incidence was higher among males with birth weight ≤1000g. There was an incidence of 5.21% of visual disability, with 0.5% of children being blind in one or both eyes. Cerebral palsy was associated with retinopathy of prematurity, severe intraventricular haemorrhage, and periventricular leukomalacia, in particular cystic periventricular leukomalacia.
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Affiliation(s)
- P García
- Unidad de Neonatología, Hospital Universitario de Salamanca, Salamanca, España.
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Iacobelli S, Bonsante F, Quantin C, Robillard PY, Binquet C, Gouyon JB. Total plasma protein in very preterm babies: prognostic value and comparison with illness severity scores. PLoS One 2013; 8:e62210. [PMID: 23614036 PMCID: PMC3628347 DOI: 10.1371/journal.pone.0062210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 03/18/2013] [Indexed: 11/19/2022] Open
Abstract
Objective We aimed to investigate the predictive value for severe adverse outcome of plasma protein measurements on day one of life in very preterm infants and to compare total plasma protein levels with the validated illness severity scores CRIB, CRIB-II, SNAP-II and SNAPPE-II, regarding their predictive ability for severe adverse outcome. Methods We analyzed a cohort of infants born at 24–31 weeks gestation, admitted to the tertiary intensive care unit of a university hospital over 10.5 years. The outcome measure was “severe adverse outcome” defined as death before discharge or severe neurological injury on cranial ultrasound. The adjusted odd ratio (aOR) and 95% confidence interval (95% CI) of severe adverse outcome for hypoproteinemia (total plasma protein level <40 g/L) was calculated by univariate and multivariate analyses. Calibration (Hosmer-Lemeshow goodness-of-fit) was performed and the predictive ability for severe adverse outcome was assessed for total plasma protein and compared with CRIB, CRIB-II, SNAP-II and SNAPPE-II, by calculating receiver operating characteristic (ROC) curves and their associated area under the curve (AUC). Results 761 infants were studied: 14.4% died and 4.1% survived with severe cerebral ultrasound findings. The aOR of severe adverse outcome for hypoproteinemia was 6.1 (95% CI 3.8–9.9). The rank order for variables, as assessed by AUCs and 95% CIs, in predicting outcome was: total plasma protein [0.849 (0.821–0.873)], SNAPPE-II [0.822 (0.792–0.848)], CRIB [0.821 (0.792–0.848)], SNAP-II [0.810 (0.780–0.837)] and CRIB-II [0.803 (0.772–0.830)]. Total plasma protein predicted severe adverse outcome significantly better than CRIB-II and SNAP-II (both p<0.05). Calibration for total plasma protein was very good. Conclusions Early hypoproteinemia has prognostic value for severe adverse outcome in very preterm, sick infants. Total plasma protein has a predictive performance comparable with CRIB and SNAPPE-II and greater than other validated severity scores.
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Affiliation(s)
- Silvia Iacobelli
- Néonatologie, Réanimation Néonatale et Pédiatrique, CHU La Réunion-Site Sud, Saint Pierre, France.
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Toome L, Varendi H, Männamaa M, Vals MA, Tänavsuu T, Kolk A. Follow-up study of 2-year-olds born at very low gestational age in Estonia. Acta Paediatr 2013; 102:300-7. [PMID: 23176138 DOI: 10.1111/apa.12091] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 10/08/2012] [Accepted: 11/13/2012] [Indexed: 11/29/2022]
Abstract
AIM To study very low gestational age (VLGA, <32 weeks) infants at 2 years of age and to identify the predictors of adverse outcomes. METHODS A population-based cohort of 155 surviving VLGA infants born in Estonia in 2007 was followed up and compared with a matched full-term (FT) control group. A logistic regression model was used to test associations between risk factors and adverse outcomes. RESULTS No impairment was found in 60% of the VLGA infants. Neurodevelopmental impairment was noted in 12% of VLGA infants, with 8% of the infants affected by cerebral palsy without independent walking, 5% with cognitive delay, 10% with language delay and 1% with hearing impairment. The differences between preterm and FT infants in terms of the mean Cognitive, Language, and Motor Composite Scores assessed using the Bayley-III scales were in excess of 0.5 SD. Somatic growth delay was a significant problem among preterm infants. The existence of severe neonatal cerebral lesions was the most significant predictor of adverse outcomes. CONCLUSION In all domains studied, adverse conditions were more prevalent among VLGA infants than among the FT control group. Efforts to reduce neonatal morbidity in preterm infants should be a key priority for health care in Estonia.
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Affiliation(s)
- Liis Toome
- Department of Paediatrics, University of Tartu, Tartu, Estonia.
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20
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Ballot DE, Potterton J, Chirwa T, Hilburn N, Cooper PA. Developmental outcome of very low birth weight infants in a developing country. BMC Pediatr 2012; 12:11. [PMID: 22296705 PMCID: PMC3293066 DOI: 10.1186/1471-2431-12-11] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 02/01/2012] [Indexed: 11/15/2022] Open
Abstract
Background Advances in neonatal care allow survival of extremely premature infants, who are at risk of handicap. Neurodevelopmental follow up of these infants is an essential part of ongoing evaluation of neonatal care. The neonatal care in resource limited developing countries is very different to that in first world settings. Follow up data from developing countries is essential; it is not appropriate to extrapolate data from units in developed countries. This study provides follow up data on a population of very low birth weight (VLBW) infants in Johannesburg, South Africa. Methods The study sample included all VLBW infants born between 01/06/2006 and 28/02/2007 and discharged from the neonatal unit at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Bayley Scales of Infant and Toddler Development Version 111 (BSID) 111 were done to assess development. Regression analysis was done to determine factors associated with poor outcome. Results 178 infants were discharged, 26 were not available for follow up, 9 of the remaining 152 (5.9%) died before an assessment was done; 106 of the remaining 143 (74.1%) had a BSID 111 assessment. These 106 patients form the study sample; mean birth weight and mean gestational age was 1182 grams (SD: 197.78) and 30.81 weeks (SD: 2.67) respectively. The BSID (111) was done at a median age of 16.48 months. The mean cognitive subscale was 88.6 (95% CI: 85.69 - 91.59), 9 (8.5%) were < 70, mean language subscale was 87.71 (95% CI: 84.85 - 90.56), 10 (9.4%) < 70, and mean motor subscale was 90.05 (95% CI: 87.0 - 93.11), 8 (7.6%) < 70. Approximately one third of infants were identified as being at risk (score between 70 and 85) on each subscale. Cerebral palsy was diagnosed in 4 (3.7%) of babies. Factors associated with poor outcome included cystic periventricular leukomalacia (PVL), resuscitation at birth, maternal parity, prolonged hospitalisation and duration of supplemental oxygen. PVL was associated with poor outcome on all three subscales. Birth weight and gestational age were not predictive of neurodevelopmental outcome. Conclusion Although the neurodevelopmental outcome of this group of VLBW infants was within the normal range, with a low incidence of cerebral palsy, these results may reflect the low survival of babies with a birth weight below 900 grams. In addition, mean subscale scores were low and one third of the babies were identified as "at risk", indicating that this group of babies warrants long-term follow up into school going age.
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Affiliation(s)
- Daynia E Ballot
- Department of Paediatrics and Child Health, University of the Witwatersrand, PO Wits 2050, South Africa.
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Berrington JE, Hearn RI, Bythell M, Wright C, Embleton ND. Deaths in preterm infants: changing pathology over 2 decades. J Pediatr 2012; 160:49-53.e1. [PMID: 21868028 DOI: 10.1016/j.jpeds.2011.06.046] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 05/11/2011] [Accepted: 06/30/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To establish how cause of death for live-born preterm infants (24-31 weeks gestation) has changed in a single large UK population over 2 decades. STUDY DESIGN This was an interrogation of a population-based survey of >680, 000 live births (between 1988 and 2008) for deaths in the first postnatal year. We collected cause of death grouped into major etiologies: respiratory, infection, malformation, necrotizing enterocolitis (NEC), and other. Data were analyzed in three 7-year epochs and 2 gestational groups (<27 and 28-31 weeks). Numbers, rates per 1000 live births, and proportional contributions to each epoch were analyzed. RESULTS A total of 1504 deaths occurred. The infants who died had a median gestational age of 26 weeks (IQR, 25-28 weeks) and a median birth weight of 880 g (IQR, 700-1170 g). The number of deaths decreased with each later epoch (from 671 to 473 and then to 360), as did the proportion of deaths from respiratory causes (64% to 62% and then to 49%). The proportion of deaths occurring after 40 weeks postmenstrual age remained stable across the 3 epochs (8.8%, 8%, and 8%). Deaths from infection and NEC increased with time (from 11% to 13% and then to 21%), as did median time to death (from 2.7 to 3.8 days). CONCLUSION Infection and NEC are increasingly prevalent causes of death in preterm infants.
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Affiliation(s)
- Janet Elizabeth Berrington
- Newcastle Neonatal Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
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Muraskas JK, Rau BJ, Castillo PR, Gianopoulos J, Boyd LAC. Long-term follow-up of 2 newborns with a combined birth weight of 540 grams. Pediatrics 2012; 129:e174-8. [PMID: 22157130 DOI: 10.1542/peds.2010-0039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Long-term growth and developmental data are presented for the smallest and third smallest surviving newborns in the world literature to 5 and 20 years of age, respectively. Both patients exhibited normal motor and language development. Although head circumference for both newborns demonstrated catchup growth, significant differences in height and weight growth velocities persisted.
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Affiliation(s)
- Jonathan K Muraskas
- Division of Neonatal-Perinatal Medicine, Loyola University Medical Center, 2160 S 1st Ave, 107-5810, Maywood, IL 60153, USA.
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Abstract
Over the last 50 years in the United States a rising preterm birth rate, a progressive decrease in preterm mortality, and a lowering of the limit of viability have made preterm birth a significant public health problem. Neuromaturation, the functional development of the central nervous system (CNS), is a dynamic process that promotes and shapes CNS structural development. This article reviews preterm outcomes, recognizing that multiple factors influence neuromaturation and lead to a range of neurodevelopmental disabilities, dysfunctions, and altered CNS processing. Ways to protect preterm infants and support their growth and development in and beyond intensive care are examined.
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Affiliation(s)
- Marilee C Allen
- Division of Neonatology, Department of Pediatrics, Baltimore, MD 21287, USA.
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Barre N, Morgan A, Doyle LW, Anderson PJ. Language abilities in children who were very preterm and/or very low birth weight: a meta-analysis. J Pediatr 2011; 158:766-774.e1. [PMID: 21146182 DOI: 10.1016/j.jpeds.2010.10.032] [Citation(s) in RCA: 242] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 09/28/2010] [Accepted: 10/20/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To conduct a meta-analysis to characterize differences in language ability between children born very preterm (VPT, <32 weeks' gestational age), with a very low birth weight (VLBW, <1500 g), or both and in term-born control children. STUDY DESIGN Electronic databases were systematically searched, and 12 studies met the inclusion criteria. Effect sizes were calculated to compare VPT/VLBW children and control children. RESULTS VPT/VLBW children performed between 0.38 and 0.77 SD below control subjects in the areas of expressive and receptive language overall and expressive and receptive semantics. Results for expressive and receptive grammar were equivocal. Subgroup analysis of school-aged children revealed similar results. No studies assessing phonological awareness, discourse, or pragmatics were identified. CONCLUSIONS Language ability is reduced in VPT/VLBW children. When considering only school-aged children, this reduction is still present, suggesting that their difficulty appears to be ongoing. Rigorous studies examining a range of language subdomains are needed to fully understand the specific nature of language difficulties in this population.
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Affiliation(s)
- Natalie Barre
- Murdoch Children Research Institute, Victoria, Australia.
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25
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Brosch JR, Sant RV, Golomb MR. Subacute onset of abnormal gait and head drop in a 3-year-old with history of extreme prematurity. J Child Neurol 2011; 26:373-6. [PMID: 21257840 DOI: 10.1177/0883073810382142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 3-year-old boy who had been a 23-week premature infant had subacute onset of abnormal gait, which progressed to generalized weakness with severe weakness of neck extensors. He had U waves on electrocardiography. His serum potassium was 1.8 mmol/L. The patient had a gastrostomy tube due to chronic feeding issues and was treated with inhaled albuterol for chronic lung disease. When his oral intake regressed, his family administered one of his oral supplements through the gastrostomy tube; the supplement was low in potassium. This feeding regression continued for several months. He had no additional gastrointestinal or renal loss of potassium. He had frequent exacerbations of his bronchopulmonary dysplasia. His history suggested he had chronic potassium depletion and that albuterol may have led to further potassium redistribution, exacerbating his hypokalemia. As more extremely premature infants survive with chronic feeding and respiratory issues, this presentation may become more common.
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Affiliation(s)
- Jared R Brosch
- Indiana University School of Medicine, Department of Neurology, Indianapolis, IN 46202, USA
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Lind A, Korkman M, Lehtonen L, Lapinleimu H, Parkkola R, Matomäki J, Haataja L. Cognitive and neuropsychological outcomes at 5 years of age in preterm children born in the 2000s. Dev Med Child Neurol 2011; 53:256-62. [PMID: 21166668 DOI: 10.1111/j.1469-8749.2010.03828.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to assess the cognitive level and neuropsychological performance at 5 years of age in children with a very low birthweight (VLBW; birthweight <1501 g) born in 2001 to 2003. METHOD A regional cohort of 97 children with a VLBW (mean gestational age 28 wks [SD 3 wks]; mean birthweight 1054 g [SD 259 g]; 50 male; 47 female) and a comparison group of 161 healthy children born at term (mean gestational age 40 wks [SD 1 wks]; mean birthweight 3644 g [SD 446 g]; 80 male; 81 female) were included in this study. At 5 years of age (SD 2 mo) cognitive level was assessed with the Wechsler Preschool and Primary Scale of Intelligence - revised and neuropsychological performance was assessed using NEPSY II. RESULTS The mean intelligence of the VLBW group corresponded to the normative mean of 100 but was lower than the mean of the low-risk comparison group (p<0.001). Neuropsychological performance was also significantly poorer than that of the comparison group. In NEPSY II, 25% of the VLBW group had a significantly impaired performance in one of 11 subtests and 33% had a significantly impaired performance in more than one, while 19% of the comparison group had a significantly impaired performance in one subtest and 10% had a significantly impaired performance in more than one. INTERPRETATION The mean cognitive capacity of the VLBW cohort corresponded to the normative mean. However, assessments of cognitive level only at preschool age do not provide the information on neuropsychological deficit that is necessary for planning adequate educational support.
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Affiliation(s)
- Annika Lind
- Department of Pediatrics, Turku University Hospital, Turku, Finland
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Baron IS, Erickson K, Ahronovich MD, Baker R, Litman FR. Neuropsychological and Behavioral Outcomes of Extremely Low Birth Weight at Age Three. Dev Neuropsychol 2011; 36:5-21. [DOI: 10.1080/87565641.2011.540526] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ida Sue Baron
- Department of Pediatrics, Inova Fairfax Hospital for Children, Falls Church, Virginia 22042, USA.
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Holsti L. A preventive care program for very preterm infants improves infant behavioural outcomes and decreases anxiety and depression in caregivers. J Physiother 2011; 56:277. [PMID: 21213943 DOI: 10.1016/s1836-9553(10)70012-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Tlucek PS, Corff KE, Bright BC, Bedwell SM, Sekar KC, Siatkowski RM. Effect of decreasing target oxygen saturation on retinopathy of prematurity. J AAPOS 2010; 14:406-11. [PMID: 21035066 DOI: 10.1016/j.jaapos.2010.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 06/27/2010] [Accepted: 06/30/2010] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The authors of previous studies suggest that the oxygenation status of premature infants contributes to the development of retinopathy of prematurity (ROP). In this study we compared the incidence and severity of ROP before and after institution of a new neonatal intensive care unit oxygen protocol. METHODS A retrospective chart review was performed of all eligible inborn patients screened for ROP during the 2 years immediately before (Group 1) to and the 2 years after (Group 2) the initiation of a new oxygen protocol. In the new protocol, target oxygen saturation was adjusted from 90%-99% to 85%-93%. Treatment criteria adhered to Early Treatment for Retinopathy of Prematurity guidelines for the study's duration. RESULTS There were 387 infants in Group 1 and 386 infants in Group 2 (descriptive statistics adjusted for correlation due to multiple births). Mean birth weights (BWs) and gestational ages were 1,194 g and 29.2 weeks (ranges, 525-2,085 g; 23 2/7-39 6/7 weeks) for Group 1 and 1,139 g and 28.9 weeks (ranges, 520-2,500 g; 22 6/7-35 3/7 weeks) for Group 2 (p = 0.02/0.10). ROP developed in 32.7% of infants in Group 1 and 27.8% in Group 2 (p = 0.17). The incidence of ROP requiring treatment was 19.9% in Group 1 and 20.5% in Group 2 (p = 0.91). Subanalysis of infants with BW ≤ 1,000g (Group 1, n = 119; Group 2, n = 141) revealed ROP incidence of 75.1% versus 57.1%, respectively (p < 0.01); treatable disease occurred in 37.5% and 21.9% of affected infants (p = 0.19). CONCLUSIONS Lowering target oxygen saturation for inborn premature infants was associated with decreased incidence of ROP only in infants with BW ≤ 1,000 g. Severity of disease, including need for treatment, was similar in both groups.
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Affiliation(s)
- Paul S Tlucek
- The Children's Hospital of Oklahoma and Dean A. McGee Eye Institute, Oklahoma City, Oklahoma, USA
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Brennan CM, Taylor GA. Sonographic imaging of the posterior fossa utilizing the foramen magnum. Pediatr Radiol 2010; 40:1411-6. [PMID: 20336286 DOI: 10.1007/s00247-010-1635-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 01/27/2010] [Accepted: 02/23/2010] [Indexed: 11/24/2022]
Abstract
In this essay, we describe our experience with a sonographic technique utilizing the foramen magnum to more clearly define anatomy in the neonatal posterior fossa. This approach can be used as an additional problem-solving tool in neonates with post-hemorrhagic hydrocephalus and a variety of posterior fossa abnormalities. The foramen magnum view is easily mastered and produces diagnostic images with little additional scanning time.
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Inder T. Imaging insights of alterations and adaptations in the preterm and late preterm brain. J Pediatr 2010; 156:867-868. [PMID: 20493317 DOI: 10.1016/j.jpeds.2010.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 04/05/2010] [Indexed: 10/19/2022]
Affiliation(s)
- Terrie Inder
- Department of Pediatrics, St. Louis Children's Hospital, Washington University, St. Louis, Missouri.
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Parappil H, Rahman S, Salama H, Rifai HA, Parambil NK, Ansari WE. Outcomes of 28+1 to 32+0 weeks gestation babies in the state of Qatar: finding facility-based cost effective options for improving the survival of preterm neonates in low income countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2010; 7:2526-42. [PMID: 20644688 PMCID: PMC2905565 DOI: 10.3390/ijerph7062526] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 05/31/2010] [Accepted: 06/02/2010] [Indexed: 11/16/2022]
Abstract
In this retrospective study we did a comparative analysis of the outcome of 28(+1) to 32(+0) weeks gestation babies between the State of Qatar and some high income countries with an objective of providing an evidence base for improving the survival of preterm neonates in low income countries. Data covering a five year period (2002-2006) was ascertained on a pre-designed Performa. A comparative analysis with the most recent data from VON, NICHD, UK, France and Europe was undertaken. Qatar's 28(+1) to 32(+0) weeks Prematurity Rate (9.23 per 1,000 births) was less than the UK's (p < 0.0001). Of the 597 babies born at 28(+1) to 32(+0) weeks of gestation, 37.5% did not require any respiratory support, while 31.1% required only CPAP therapy. 80.12% of the MV and 96.28% of CPAP therapy was required for <96 hours. 86.1% of the mothers had received antenatal steroids. The 28(+1) to 32(+0) weeks mortality rate was 65.3/1,000 births with 30.77% deaths attributable to a range of lethal congenital and chromosomal anomalies. The survival rate increased with increasing gestational age (p < 0.001) and was comparable to some high income countries. The incidence of in hospital pre discharge morbidities in Qatar (CLD 2.68%, IVH Grade III 0.84%, IVH Grade IV 0.5%, Cystic PVL 0.5%) was less as compared to some high income countries except ROP >/= Stage 3 (5.69%), which was higher in Qatar. The incidence of symptomatic PDA, NEC and severe ROP decreased with increasing gestational age (p < 0.05). We conclude that the mortality and in hospital pre discharge morbidity outcome of 28(+1) to 32(+0) weeks babies in Qatar are comparable with some high income countries. In two thirds of this group of preterm babies, the immediate postnatal respiratory distress can be effectively managed by using two facility based cost effective interventions; antenatal steroids and postnatal CPAP. This finding is very supportive to the efforts of international perinatal health care planners in designing facility-based cost effective options for low income countries.
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Affiliation(s)
- Hussain Parappil
- NICU Women’s Hospital, Hamad Medical Corporation, Doha, Qatar; E-Mails: (H.P.); (H.S.); (H.A.R.); (N.K.P.)
- Department of Paediatrics, Weill Cornell Medical College, Doha, Qatar
| | - Sajjad Rahman
- NICU Women’s Hospital, Hamad Medical Corporation, Doha, Qatar; E-Mails: (H.P.); (H.S.); (H.A.R.); (N.K.P.)
- Department of Paediatrics, Weill Cornell Medical College, Doha, Qatar
| | - Husam Salama
- NICU Women’s Hospital, Hamad Medical Corporation, Doha, Qatar; E-Mails: (H.P.); (H.S.); (H.A.R.); (N.K.P.)
- Department of Paediatrics, Weill Cornell Medical College, Doha, Qatar
| | - Hilal Al Rifai
- NICU Women’s Hospital, Hamad Medical Corporation, Doha, Qatar; E-Mails: (H.P.); (H.S.); (H.A.R.); (N.K.P.)
- Department of Paediatrics, Weill Cornell Medical College, Doha, Qatar
| | - Najeeb Kesavath Parambil
- NICU Women’s Hospital, Hamad Medical Corporation, Doha, Qatar; E-Mails: (H.P.); (H.S.); (H.A.R.); (N.K.P.)
- Department of Paediatrics, Weill Cornell Medical College, Doha, Qatar
| | - Walid El Ansari
- Faculty of Sport, Health and Social Care, University of Gloucestershire, Gloucester, UK; E-Mail:
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Munck P, Haataja L, Maunu J, Parkkola R, Rikalainen H, Lapinleimu H, Lehtonen L. Cognitive outcome at 2 years of age in Finnish infants with very low birth weight born between 2001 and 2006. Acta Paediatr 2010; 99:359-66. [PMID: 19912142 DOI: 10.1111/j.1651-2227.2009.01589.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To study cognitive outcome of premature, very low birth weight (VLBW) infants in relation to parental education and neonatal data. METHODS A regional cohort of 182 VLBW infants born between 2001 and 2006 was followed up. Brain ultrasounds (US) were examined serially until term age and brain magnetic resonance imaging at term age. Neurological status was examined systematically. Cognitive development was assessed using the Mental Developmental Index (MDI) of Bayley Scales at 2 years of corrected age. A total of 192 healthy full-term (FT) controls were assessed with the MDI at 2 years of age. RESULTS The mean MDI in VLBW infants was 101.7 (SD 15.4), which was lower compared with FT controls (109.8, SD 11.7, p < 0.001). In regression analysis of the demographic and medical data of VLBW infants, postnatal corticosteroids (p = 0.04), intestinal perforation (p = 0.03) and major brain pathology (p = 0.02) were negatively associated with the MDI. In VLBW infants, the prevalence of neurodevelopmental impairment was 9.9% (3.3% MDI below 70, 7.1% cerebral palsy, 2.2% hearing aid, no blind infants). CONCLUSION Cognitive development of VLBW infants seemed to have improved in comparison with earlier publications, but it differed from the FT controls. Neonatal factors affected cognitive development. Therefore, updated regional follow-up data are important for clinicians.
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Affiliation(s)
- P Munck
- Department of Pediatrics, Turku University Hospital, Turku, Finland.
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