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Xu Z, Wu Y, Mao J, Chen Y, Chen H, Zhang S, Yu J, Deng X, Shen L. 4D label-free proteomics analysis of oxygen-induced retinopathy with or without anti-VEGF treatment. BMC Genomics 2024; 25:415. [PMID: 38671350 PMCID: PMC11046906 DOI: 10.1186/s12864-024-10340-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 04/23/2024] [Indexed: 04/28/2024] Open
Abstract
Oxygen-induced retinopathy (OIR) animal model is widely used for retinopathy of prematurity (ROP) researches. The purpose of this study was to identify proteins and related pathways of OIR with or without anti-vascular endothelial growth factor (VEGF) treatment, for use as biomarkers in diagnosing and treating ROP. Nine samples were subjected to proteomic analysis. Retina specimens were collected from 3 OIR mice, 3 OIR mice with anti-VEGF treatment and 3 normal mice (control group). Liquid chromatography-tandem mass spectrometry analysis was performed using the 4D label-free technique. Statistically significant differentially expressed proteins, gene ontology (GO) terms, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway representations, InterPro (IPR) and protein interactions were analyzed. In total, 4585 unique proteins were identified as differentially expressed proteins (DEPs). Enrichment analysis of the GO and KEGG indicated functional clusters related to peptide biosynthetic and metabolic process, cellular macromolecule biosynthetic process and nucleic acid binding in OIR group. For anti-VEGF treatment group, DEPs were clustered in DNA replication, PI3K/Akt signaling pathway and Jak/STAT signaling pathway. Proteomic profiling is useful for the exploration of molecular mechanisms of OIR and mechanisms of anti-VEGF treatment. These findings may be useful for identification of novel biomarkers for ROP pathogenesis and treatment.
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Affiliation(s)
- Zhaokai Xu
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Yubo Wu
- Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Jianbo Mao
- Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Yiqi Chen
- Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Huan Chen
- Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Shian Zhang
- Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Jiafeng Yu
- Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Xinyi Deng
- Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Lijun Shen
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
- Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China.
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2
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van Hasselt TJ, Gale C, Battersby C, Davis PJ, Draper E, Seaton SE. Paediatric intensive care admissions of preterm children born <32 weeks gestation: a national retrospective cohort study using data linkage. Arch Dis Child Fetal Neonatal Ed 2024; 109:265-271. [PMID: 37923384 DOI: 10.1136/archdischild-2023-325970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Survival of babies born very preterm (<32 weeks gestational age) has increased, although preterm-born children may have ongoing morbidity. We aimed to investigate the risk of admission to paediatric intensive care units (PICUs) of children born very preterm following discharge home from neonatal care. DESIGN Retrospective cohort study, using data linkage of National Neonatal Research Database and the Paediatric Intensive Care Audit Network datasets. SETTING All neonatal units and PICUs in England and Wales. PATIENTS Children born very preterm between 1 January 2013 and 31 December 2018 and admitted to neonatal units. MAIN OUTCOME MEASURES Admission to PICU after discharge home from neonatal care, before 2 years of age. RESULTS Of the 40 690 children discharged home from neonatal care, there were 2308 children (5.7%) with at least one admission to PICU after discharge. Of these children, there were 1901 whose first PICU admission after discharge was unplanned.The percentage of children with unplanned PICU admission varied by gestation, from 10.2% of children born <24 weeks to 3.3% born at 31 weeks.Following adjustment, unplanned PICU admission was associated with lower gestation, male sex (adjusted OR (aOR) 0.79), bronchopulmonary dysplasia (aOR 1.37), necrotising enterocolitis requiring surgery (aOR 1.39) and brain injury (aOR 1.42). For each week of increased gestation, the aOR was 0.90. CONCLUSIONS Most babies born <32 weeks and discharged home from neonatal care do not require PICU admission in the first 2 years. The odds of unplanned admissions to PICU were greater in the most preterm and those with significant neonatal morbidity.
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Affiliation(s)
- Tim J van Hasselt
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Cheryl Battersby
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Peter J Davis
- Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Elizabeth Draper
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Sarah E Seaton
- Department of Population Health Sciences, University of Leicester, Leicester, UK
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3
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Msall ME. Improving neurodevelopmental trajectories after retinopathy of prematurity: challenges and opportunities. Pediatr Res 2023; 94:1598-1599. [PMID: 35292728 DOI: 10.1038/s41390-022-02019-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Michael E Msall
- University of Chicago Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, 950 East 61st Street Room 207, Chicago, IL, 60637, USA.
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4
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Starke V, Diderholm B, Heyman M, Blomqvist YT. Being parents of extremely preterm children, from a long-term perspective: A qualitative study of parents' experiences. Early Hum Dev 2023; 183:105819. [PMID: 37393662 DOI: 10.1016/j.earlhumdev.2023.105819] [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: 05/15/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND In recent decades, modern neonatal intensive care has improved, increasing the survival of extremely preterm children. Few studies have examined the experiences of parents of extremely preterm children from a long-term perspective. AIM To describe parents' experiences of parenting extremely preterm children during their childhood and transition to adulthood. STUDY DESIGN A qualitative interview study with a descriptive design. SUBJECTS Thirteen parents of eleven children born at 24 gestational weeks in Sweden, 1990-1992, participated in individual semi-structured interviews. OUTCOME MEASURES Data were analyzed using qualitative reflexive thematic analysis. RESULT Five themes forming a timeline were created in the analytic process: parenthood, at the NICU, young childhood, adolescence, and adulthood. Various aspects affecting parenthood were described throughout the timeline, and occasionally the parents experienced difficulties dealing with their children's special physical and/or mental needs. Today, some families have established a functioning situation despite their children's physical and/or mental difficulties, while some still struggle with their children's everyday life. CONCLUSION Having an extremely preterm family member profoundly affects the whole family for various lengths of time. Parents expressed a need for support from both healthcare and school throughout their children's childhood and in their transition to adulthood, although the need varies between parent-child pairs. By studying the parents' experiences, their need for support can be further recognized and understood, and developed and improved accordingly.
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Affiliation(s)
- Veronica Starke
- Department of Women's and Children's Health, Uppsala University, Sweden.
| | - Barbro Diderholm
- Department of Women's and Children's Health, Uppsala University, Sweden
| | - Maria Heyman
- Department of Women's and Children's Health, Uppsala University, Sweden
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5
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Lucchesi M, Marracci S, Amato R, Filippi L, Cammalleri M, Dal Monte M. Neurosensory Alterations in Retinopathy of Prematurity: A Window to Neurological Impairments Associated to Preterm Birth. Biomedicines 2022; 10:biomedicines10071603. [PMID: 35884908 PMCID: PMC9313429 DOI: 10.3390/biomedicines10071603] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/21/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022] Open
Abstract
Retinopathy of prematurity (ROP) is one of the main blinding diseases affecting preterm newborns and is classically considered a vascular disorder. The premature exposure to the extrauterine environment, which is hyperoxic in respect to the intrauterine environment, triggers a cascade of events leading to retinal ischemia which, in turn, makes the retina hypoxic thus setting off angiogenic processes. However, many children with a history of ROP show persistent vision impairment, and there is evidence of an association between ROP and neurosensory disabilities. This is not surprising given the strict relationship between neuronal function and an adequate blood supply. In the present work, we revised literature data evidencing to what extent ROP can be considered a neurodegenerative disease, also taking advantage from data obtained in preclinical models of ROP. The involvement of different retinal cell populations in triggering the neuronal damage in ROP was described along with the neurological outcomes associated to ROP. The situation of ROP in Italy was assessed as well.
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Affiliation(s)
- Martina Lucchesi
- Department of Biology, University of Pisa, 56127 Pisa, Italy; (M.L.); (S.M.); (R.A.); (M.C.)
| | - Silvia Marracci
- Department of Biology, University of Pisa, 56127 Pisa, Italy; (M.L.); (S.M.); (R.A.); (M.C.)
| | - Rosario Amato
- Department of Biology, University of Pisa, 56127 Pisa, Italy; (M.L.); (S.M.); (R.A.); (M.C.)
| | - Luca Filippi
- Department of Clinical and Experimental Medicine, Division of Neonatology and NICU, University of Pisa, 56126 Pisa, Italy;
| | - Maurizio Cammalleri
- Department of Biology, University of Pisa, 56127 Pisa, Italy; (M.L.); (S.M.); (R.A.); (M.C.)
| | - Massimo Dal Monte
- Department of Biology, University of Pisa, 56127 Pisa, Italy; (M.L.); (S.M.); (R.A.); (M.C.)
- Correspondence: ; Tel.: +39-050-2211426
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6
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Chen R, Sjölander A, Johansson S, Lu D, Razaz N, Tedroff K, Villamor E, Cnattingius S. Impact of gestational age on risk of cerebral palsy: unravelling the role of neonatal morbidity. Int J Epidemiol 2022; 50:1852-1863. [PMID: 34999876 PMCID: PMC8743109 DOI: 10.1093/ije/dyab131] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The contribution of adverse consequences of preterm birth to gestational-age-related risk of cerebral palsy (CP) has rarely been studied. We aimed to assess the potential mediating roles of neonatal morbidity on the association between gestational age and risk of CP. METHODS In this Swedish population-based study, 1 402 240 singletons born at 22-40 gestational weeks during 1998-2016 were followed from day 28 after birth for a CP diagnosis until 2017. Potential mediators included asphyxia, respiratory-related, infection-/inflammatory-related and neurological-related diseases within 0-27 days of life. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Causal mediation analysis was performed to estimate the proportion of the association mediated through pathways involving the four sequential mediators. RESULTS We found an inverse dose-response relationship between gestational age and risk of CP, where the strongest association was observed for 22-24 weeks (HR 47.26, 95% CI 34.09-65.53) vs 39-40 weeks. Compared with non-diseased peers, children with neonatal morbidity, particularly those with neurological-related diseases (HR 31.34, 95% CI 26.39-37.21), had a higher risk of CP. The increased risk of CP was, at 24 weeks, almost entirely explained by neonatal morbidity (91.7%); this proportion decreased to 46.1% and 16.4% at 32 and 36 weeks, respectively. Asphyxia was the main mediating pathway from 22 to 34 weeks, and neurological-related neonatal diseases led the mediating pathways from 34 weeks onwards. CONCLUSION Neonatal morbidity mediates a large proportion of the effect of preterm birth on CP, but the magnitude declines as gestational age increases.
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Affiliation(s)
- Ruoqing Chen
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Johansson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
| | - Donghao Lu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Neda Razaz
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Tedroff
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Eduardo Villamor
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Sven Cnattingius
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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7
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Wang L, Zhong WH, Liu DY, Shen HQ, He ZJ. Metabolic analysis of infants with bronchopulmonary dysplasia under early nutrition therapy: An observational cohort study. Exp Biol Med (Maywood) 2021; 247:470-479. [PMID: 34894806 DOI: 10.1177/15353702211060513] [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: 11/15/2022] Open
Abstract
To assess the amino acid and fatty acid metabolite patterns between infants with and without bronchopulmonary dysplasia in different nutritional stages after birth and identify metabolic indicators of bronchopulmonary dysplasia. This was an observational cohort of preterm infants born at a gestational age ≤32 + 6 weeks and with a body weight ≤2000 g. Amino acid and carnitine profiles were measured in dried blood spots (DBSs) during the early nutrition transitional phase using tandem mass spectrometry. Bronchopulmonary dysplasia was defined as oxygen dependence at 36 weeks of postmenstrual age or 28 days after birth. Metabolomic analysis was employed to define metabolites with significant differences, map significant metabolites into pathways, and identify metabolic indicators of bronchopulmonary dysplasia. We evaluated 45 neonates with and 40 without bronchopulmonary dysplasia. Four amino acids and three carnitines showed differences between the groups. Three carnitines (C0, C2, and C6:1) were high in the bronchopulmonary dysplasia group mostly; conversely, all four amino acids (threonine, arginine, methionine, and glutamine (Gln)) were low in the bronchopulmonary dysplasia group. Pathway analysis of these metabolites revealed two pathways with significant changes (p < 0.05). ROC analysis showed Gln/C6:1 at total parenteral nutrition phase had both 80% sensitivity and specificity for predicting the development of bronchopulmonary dysplasia, with an area under the curve of 0.81 (95% confidence interval 0.71-0.89). Amino acid and fatty acid metabolite profiles changed in infants with bronchopulmonary dysplasia after birth during the nutrition transitional period, suggesting that metabolic dysregulation may participate in the development of bronchopulmonary dysplasia. Our findings demonstrate that metabolic indicators are promising for forecasting the occurrence of bronchopulmonary dysplasia among preterm neonates.
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Affiliation(s)
- Li Wang
- Department of Neonatology, Xinhua Hospital Affiliated to Shanghai JiaoTong University School of Medicine, Shanghai 200092, China
| | - Wen Hua Zhong
- Department of Neonatology, Xinhua Hospital Affiliated to Shanghai JiaoTong University School of Medicine, Shanghai 200092, China.,Department of Neonatology, Jiaxing Maternity and Child Health Care Hospital, Jiaxing 314001, China
| | - Dan Yang Liu
- Department of Neonatology, Jingan District Zhabei Central Hospital, Shanghai 200070, China
| | - Hai Qing Shen
- Department of Neonatology, International Peace Maternity and Child Health Hospital of China Welfare Institute, Shanghai 200030, China *These authors have contributed equally to this work
| | - Zhen Juan He
- Department of Neonatology, Xinhua Hospital Affiliated to Shanghai JiaoTong University School of Medicine, Shanghai 200092, China
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8
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Boland RA, Cheong JLY, Doyle LW. Changes in long-term survival and neurodevelopmental disability in infants born extremely preterm in the post-surfactant era. Semin Perinatol 2021; 45:151479. [PMID: 34493405 DOI: 10.1016/j.semperi.2021.151479] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Extremely preterm birth before 28 weeks' gestation accounts for less than 1% of births in high-income countries but is associated with high rates of perinatal and infant mortality, and of neurodevelopmental disability in surviving children. Survival rates have increased over time, both overall, and within each week of gestational age since the introduction of exogenous surfactant into clinical care in the early 1990s. However, rates of major neurodevelopmental disability in survivors, whether they be in early childhood or at school-age, have not clearly improved in parallel with the increases in survival. An important strategy to improve survival free of major neurodevelopmental disability is to birth extremely preterm infants in a tertiary perinatal center, where specialist obstetric care for the mother and ongoing intensive care for the infant can both be provided without the potential morbidities associated with postnatal transfer.
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Affiliation(s)
- Rosemarie A Boland
- Clinical Sciences, Murdoch Children's Research, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia; Paediatric Infant Perinatal Emergency Retrieval, Royal Children's Hospital, Parkville, VIC, Australia.
| | - Jeanie L Y Cheong
- Clinical Sciences, Murdoch Children's Research, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia; Neonatal Services, Royal Women's Hospital, Parkville, VIC, Australia
| | - Lex W Doyle
- Clinical Sciences, Murdoch Children's Research, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia; Neonatal Services, Royal Women's Hospital, Parkville, VIC, Australia
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9
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Predicting the outcomes of preterm neonates beyond the neonatal intensive care unit: What are we missing? Pediatr Res 2021; 89:426-445. [PMID: 32428926 PMCID: PMC7276948 DOI: 10.1038/s41390-020-0968-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 04/13/2020] [Accepted: 04/27/2020] [Indexed: 11/17/2022]
Abstract
Preterm infants are a population at high risk for mortality and adverse health outcomes. With recent improvements in survival to childhood, increasing attention is being paid to risk of long-term morbidity, specifically during childhood and young-adulthood. Although numerous tools for predicting the functional outcomes of preterm neonates have been developed in the past three decades, no studies have provided a comprehensive overview of these tools, along with their strengths and weaknesses. The purpose of this article is to provide an in-depth, narrative review of the current risk models available for predicting the functional outcomes of preterm neonates. A total of 32 studies describing 43 separate models were considered. We found that most studies used similar physiologic variables and standard regression techniques to develop models that primarily predict the risk of poor neurodevelopmental outcomes. With a recently expanded knowledge regarding the many factors that affect neurodevelopment and other important outcomes, as well as a better understanding of the limitations of traditional analytic methods, we argue that there is great room for improvement in creating risk prediction tools for preterm neonates. We also consider the ethical implications of utilizing these tools for clinical decision-making. IMPACT: Based on a literature review of risk prediction models for preterm neonates predicting functional outcomes, future models should aim for more consistent outcomes definitions, standardized assessment schedules and measurement tools, and consideration of risk beyond physiologic antecedents. Our review provides a comprehensive analysis and critique of risk prediction models developed for preterm neonates, specifically predicting functional outcomes instead of mortality, to reveal areas of improvement for future studies aiming to develop risk prediction tools for this population. To our knowledge, this is the first literature review and narrative analysis of risk prediction models for preterm neonates regarding their functional outcomes.
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10
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Commentary: …And a beer for the baby, please. Pediatr Res 2020; 88:832-833. [PMID: 32916684 DOI: 10.1038/s41390-020-01130-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/29/2020] [Indexed: 11/08/2022]
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11
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Poryo M, Maas S, Gortner L, Geipel M, Zemlin M, Löffler G, Meyer S. Effects of small for gestational age status on mortality and major morbidities in ≤750 g neonates. Early Hum Dev 2020; 144:105040. [PMID: 32325371 DOI: 10.1016/j.earlhumdev.2020.105040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/23/2020] [Accepted: 03/31/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Controversy exists regarding the impact of small for gestational age (SGA = birth weight < 10th percentile) status on mortality and major morbidities. AIM To assess the effects of SGA on mortality and major morbidities in ≤750 gram (g) neonates. STUDY DESIGN Retrospective (01/2005-12/2017), single center study at a tertiary NICU. SUBJECTS SGA neonates ≤ 750 g. OUTCOME Effect of SGA status on mortality and major morbidities. RESULTS 183 infants were enrolled. 103 (56.3%) were non-SGA (mean gestational age 25 + 1 weeks ± 9.9 days, mean birth weight 662.6 ± 75.2 g), and 80 (43.7%) SGA (mean gestational age 26 + 6 weeks ± 14.0 days, mean birth weight 543.9 ± 114.7 g). Mortality was 24.1% (non-SGA: 30/103 (29.1%), SGA: 14/80 (17.5%); p = 0.08). Univariable logistic regression analysis revealed a significant protective effect of SGA status on pneumothoraces (OR 0.28, 95%-CI [0.11-0.69]), IVH (≥3) (OR 0.38; 95%-CI [0.15-0.67]), and seizures (OR 0.09, 95%-CI [0.01-0.76]), but NEC (≥2a) occurred more frequently in SGA neonates (p = 0.024). Multiple logistic regression analysis found SGA status to negatively influence ROP (≥3) (OR 2.87, 95%-CI [1.14-7.23]) and need for home monitoring (OR 2.38, 95%-CI [1.05-5.41]). Other major morbidities (IVH, PVL, RDS, BPD, NEC, FIP, sepsis, hearing impairment) and mortality rates were not significantly affected, but distinct organ-specific patterns were seen. CONCLUSION SGA had negative effects on the rate of severe ROP and the need for home monitoring, but other major morbidities as well as mortality rates were not significantly affected. In the future, it will be important to delineate underlying pathophysiological mechanisms that contribute to this pattern.
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Affiliation(s)
- Martin Poryo
- Deparment of Pediatric Cardiology, Saarland University Medical Center, Homburg, Germany
| | - Sebastian Maas
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany
| | - Ludwig Gortner
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany
| | - Martina Geipel
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany
| | - Michael Zemlin
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany
| | - Günther Löffler
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany
| | - Sascha Meyer
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany; Section Neuropediatrics, Saarland University Medical Center, Homburg, Germany.
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12
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Vedel C, Larsen H, Holmskov A, Andreasen KR, Uldbjerg N, Ramb J, Bødker B, Skibsted L, Sperling L, Krebs L, Zingenberg H, Laursen L, Christensen JT, Tabor A, Rode L. Neonatal complications and neurophysiological development in twins - a long-term follow-up study. J Matern Fetal Neonatal Med 2020; 35:372-378. [PMID: 31986942 DOI: 10.1080/14767058.2020.1718647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: To investigate the association between neonatal complications and neurophysiological development in twins at 18 and 48-60 months of age.Methods: This was a secondary analysis of 841 Danish mono- and dichorionic diamniotic twins from a randomized controlled trial (PREDICT study), which included an assessment of the twin's neurophysiological development using the Ages and Stages Questionnaire (ASQ) that had been filled out by the parents at 18 and 48 or 60 months. The correlation within twin pairs was accounted for by the method of generalized estimating equation. Models were adjusted for maternal educational score and gestational age at delivery.Results: ASQ data were available for 823 children at 18 months and 425 children at 48 or 60 months. Low maternal educational score and preterm delivery <34 weeks were associated with a lower ASQ score at 48-60 months (-15.4 points (95%CI -26.4; -4.5) and -13.2 points (95%CI -23.8; -2.5), respectively). Neonatal sepsis and a compound of intraventricular hemorrhage, retinopathy of prematurity and necrotizing enterocolitis (IVH/ROP/NEC) were associated with lower ASQ score at 18 months (-15.3 points (95%CI -28.1; -2.5) and -30.8 points (95%CI -59.5; -2.1), respectively). Children with IVH/ROP/NEC had a lower ASQ score at 48-60 months (-34.2 points (95%CI -67.9; -0.6)). The associations were not specific to only one ASQ domain.Conclusion: Several neonatal complications are associated with poorer neurophysiological development in twins during childhood, even after adjustment for gestational age at delivery.
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Affiliation(s)
- Cathrine Vedel
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Helle Larsen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - Anni Holmskov
- Department of Obstetrics and Gynecology, Viborg Hospital, Viborg, Denmark
| | - Kirsten Riis Andreasen
- Department of Obstetrics and Gynecology, Amager and Hvidovre Hospital, Hvidovre, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Denmark
| | - Jan Ramb
- Department of Obstetrics and Gynecology, Helgelandssykehuset Mo i Rana, Mo i Rana, Norway
| | - Birgit Bødker
- Department of Obstetrics and Gynecology, Nordsjaellands Hospital, Nordsjaellands, Denmark
| | - Lillian Skibsted
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Obstetrics and Gynecology, University Hospital Roskilde, Roskilde, Denmark
| | - Lene Sperling
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Lone Krebs
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Obstetrics and Gynecology, Holbaek Hospital, Holbaek, Denmark
| | - Helle Zingenberg
- Department of Obstetrics and Gynecology, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Lone Laursen
- Department of Obstetrics, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | | | - Ann Tabor
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Line Rode
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
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Vilanova CS, Hirakata VN, de Souza Buriol VC, Nunes M, Goldani MZ, da Silva CH. The relationship between the different low birth weight strata of newborns with infant mortality and the influence of the main health determinants in the extreme south of Brazil. Popul Health Metr 2019; 17:15. [PMID: 31775758 PMCID: PMC6882357 DOI: 10.1186/s12963-019-0195-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low birth weight (LBW) newborns present different health outcomes when classified in different birth weight strata. This study evaluated the relationship of birth weight with Infant mortality (IM) through the influence of biological, social, and health care factors in a time series. METHODS Retrospective cohort study with data collected from Information Systems (Live Births and Mortality). The mortality trends were performed for each birth weight stratum: extremely low, < 1000 g; very low, 1000-1499 g; low, 1500-2499 g; insufficient, 2500-2999 g; adequate, 3000-3900 g; and macrosomia, > 4000 g. Chi-square tests analyzed IM rates. Sequential Poisson regression analyzed the impact of the determinant factors. RESULTS A total of 277,982 newborns were included in the study and 2088 died before their first year. There was a tendency for a decrease in mortality in all strata of weight. With the exception of macrosomics, all other strata had a higher risk for IM when compared with adequate birth weight. Extremely LBW newborns presented higher risk for mortality when born in a public hospital. A higher percentage of infant deaths were associated with lower maternal age and lower schooling for all strata. Prenatal care with less than three visits demonstrated a risk for IM in low, insufficient, and adequate birth weight strata. The cesarean section was a protective factor for IM in Extremely and Very LBW strata and it was a risk factor in adequate birth weight stratum. CONCLUSIONS LBW had a greater association with IM, especially those children of younger mothers and those born in public hospitals.
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Affiliation(s)
- Cássia Simeão Vilanova
- Postgraduate Program in Child and Adolescent Health, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Vânia Naomi Hirakata
- Research Group and Graduate Studies, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Viviane Costa de Souza Buriol
- Postgraduate Program in Child and Adolescent Health, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Marina Nunes
- Postgraduate Program in Child and Adolescent Health, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Marcelo Zubaran Goldani
- Postgraduate Program in Child and Adolescent Health, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Department of Pediatrics, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos 2400/Sala 414, Porto Alegre, RS 90035-003 Brazil
- Pediatrics Service, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Clécio Homrich da Silva
- Postgraduate Program in Child and Adolescent Health, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Department of Pediatrics, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos 2400/Sala 414, Porto Alegre, RS 90035-003 Brazil
- Pediatrics Service, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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Piris Borregas S, Torres Valdivieso MJ, Martín‐Arriscado C, Cruz Bértolo J, Sierra García P, Pallás Alonso CR. Model that predicted death or disabilities in premature infants was valid at seven years of age. Acta Paediatr 2019; 108:1245-1249. [PMID: 30536707 DOI: 10.1111/apa.14679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/07/2018] [Accepted: 12/03/2018] [Indexed: 11/30/2022]
Abstract
AIM Validated a model that used bronchopulmonary dysplasia (BPD), brain injuries measured using ultrasound and retinopathy of prematurity (ROP) to predict late death or disability in premature infants at seven years of age. METHODS A retrospective study was performed at the 12 de Octubre Hospital neonatal unit in Madrid. A logistic model was applied to estimate the independent prognostic contribution of each morbidity, and the effect that the combination of morbidities had on the seven-year outcomes. The analysis was performed on the total cohort from 1991 to 2008 and on two subcohorts from 1991 to 1998 and 1999 to 2008. RESULTS A total of 1001 children were included with a mean birth weight of 922 ± 208 g. Severe ROP was strongly associated with poor neurodevelopment, with an odds ratio (OR) 3.17 and 95% confidence interval (CI) of 1.56-6.50, and so was BPD (OR 1.52, 95% CI: 1.03-2.2). The combination of two neonatal morbidities increased the risk of a poor outcome (OR 4.44, 95% CI: 1.51-7.86). The model behaved differently in the two subcohorts. CONCLUSION The prognostic model predicted a poor outcome at seven years of age when the subjects had at least two of the three morbidities.
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Pinto F, Fernandes E, Virella D, Abrantes A, Neto M. Born Preterm: A Public Health Issue. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2019. [DOI: 10.1159/000497249] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Changes in long-term prognosis with increasing postnatal survival and the occurrence of postnatal morbidities in extremely preterm infants offered intensive care: a prospective observational study. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:872-879. [DOI: 10.1016/s2352-4642(18)30287-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 11/21/2022]
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17
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Holsti A, Serenius F, Farooqi A. Impact of major neonatal morbidities on adolescents born at 23-25 weeks of gestation. Acta Paediatr 2018; 107:1893-1901. [PMID: 29893052 DOI: 10.1111/apa.14445] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 06/06/2018] [Accepted: 06/08/2018] [Indexed: 12/01/2022]
Abstract
AIM More infants born extremely preterm (EPT) are surviving, but major neonatal morbidities are consistently high. This study examined the impact of bronchopulmonary dysplasia (BPD), brain injuries and severe retinopathy of prematurity (ROP) on adolescents who were born EPT. METHODS We focused on EPT infants born at 23-25 weeks at the Swedish university hospitals in Uppsala and Umeå from January 1992 to December 1998. The poor outcome data covered 140 of 142 who survived to 36 weeks, and the chronic conditions data reported by parents covered 132 of 134 still alive at 10-15 years. RESULTS Of the 140 survivors at 36 weeks, 29 (21%) had poor outcomes: eight of 140 (6%) died, and 21 of 132 (16%) adolescent survivors had severe neurodevelopmental disabilities (NDD). BPD, severe ROP and/or brain injuries correlated independently with poor outcome. Of those adolescents who were free from BPD, brain injury and severe ROP, 6% had a severe NDD. The corresponding rates with any one, any two or all three neonatal morbidities were 21, 33 and 67%, respectively. BPD and brain injuries were associated with high rates of chronic conditions at 10-15 years of age resulting in functional limitations. CONCLUSION In adolescent EPT survivors, BPD and brain injuries were associated with high rates of chronic conditions and special healthcare needs.
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Affiliation(s)
- Antti Holsti
- Department of Pediatrics; Institute of Clinical Sciences; University of Umeå; Umeå Sweden
| | - Fredrik Serenius
- Department of Pediatrics; Institute of Clinical Sciences; University of Umeå; Umeå Sweden
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - Aijaz Farooqi
- Department of Pediatrics; Institute of Clinical Sciences; University of Umeå; Umeå Sweden
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18
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Bührer C, Erdeve Ö, Bassler D, Bar-Oz B. Oral propranolol for prevention of threshold retinopathy of prematurity (ROPROP): protocol of a randomised controlled trial. BMJ Open 2018; 8:e021749. [PMID: 29982217 PMCID: PMC6042594 DOI: 10.1136/bmjopen-2018-021749] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Retinopathy of prematurity (ROP) is a disease observed in extremely premature infants characterised by visioning-threatening retinal vessel proliferation. Propranolol, a drug used for decades in newborn infants with heart diseases, hypertension and thyrotoxicosis and licenced for infantile haemangiomas, may be effective in halting progression of ROP to severe stages, as suggested by preliminary data from small studies. METHODS AND ANALYSIS ROPROP is an investigator-initiated, multicentre, placebo-controlled double-blind, randomised controlled trial aiming to assess the safety and efficacy of orally administered propranolol to reduce the risk of threshold ROP (stage 3) in extremely preterm infants at 48 weeks postmenstrual age (primary objective) and the rate of infants requiring local interventions for severe ROP (secondary objective). Key inclusion criteria: gestational age <28 weeks, birth weight <1250 g, postmenstrual age ≥31 and <37 weeks, incipient ROP (stage 1 or 2, with or without plus disease) and written informed consent by parents or legal guardian. Key exclusion criteria: requirement for open-label propranolol treatment, major congenital malformations (including those with cerebrovascular malformations), known chromosomal anomalies, colobomas and other eye malformations, atrioventricular block grade 2 or 3 and comedication with antiarrhythmics, clonidine, insulin (pharmacodynamic interaction), phenobarbital or rifampicin (pharmacokinetic interaction). The intervention consists of oral propranolol-hydrochloride (1.6 mg/kg/day in three to four divided dosages) or placebo until discharge, for a maximum of 10 weeks. Analysis is by intention to treat. ETHICS AND DISSEMINATION The protocol has received ethical and regulatory approval. Results will be published after peer review irrespective of the study outcome. TRIAL REGISTRATION NUMBERS NCT03083431 , EudraCT# 2017-002124-24 (EUCTR), 00013730 (DRKS); Pre-results.
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Affiliation(s)
- Christoph Bührer
- Department of Neonatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ömer Erdeve
- Division of Neonatology, Ankara University School of Medicine Children’s Hospital, Ankara, Turkey
| | - Dirk Bassler
- Department of Neonatology, Universitätsspital Zürich, Zurich, Switzerland
| | - Benjamin Bar-Oz
- Department of Neonatology, Hadassah Medical Center, Jerusalem, Israel
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Chen L, Bennett E, Wheeler AJ, Lyons AB, Woods GM, Johnston F, Zosky GR. Maternal exposure to particulate matter alters early post-natal lung function and immune cell development. ENVIRONMENTAL RESEARCH 2018; 164:625-635. [PMID: 29627759 DOI: 10.1016/j.envres.2018.03.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND In utero exposure to particulate matter (PM) from a range of sources is associated with adverse post-natal health; however, the effect of maternal exposure to community-sampled PM on early post-natal lung and immune development is poorly understood. OBJECTIVES Using a mouse model, we aimed to determine whether in utero exposure to PM alters early post-natal lung function and immune cell populations. We used PM collected from ceiling voids in suburban houses as a proxy for community PM exposure. METHODS Pregnant C57BL/6 mice were intranasally exposed to ceiling derived PM, or saline alone, at gestational day (E) 13.5, 15.5, and 17.5. When mice were two weeks old, we assessed lung function by the forced oscillation technique, and enumerated T and B cell populations in the spleen and thymus by flow cytometry. RESULTS Maternal exposure to PM impaired somatic growth of male offspring resulting in reduced lung volume and deficits in lung function. There was no effect on thymic T cell populations in dams and their male offspring but PM decreased the CD4 +CD25 + T cell population in the female offspring. In contrast, maternal exposure to PM increased splenic CD3 +CD4 + and CD3 +CD8 + T cells in dams, and there was some evidence to suggest inhibition of splenic T cell maturation in male but not female offspring. CONCLUSIONS Our findings suggested that maternal exposure to ceiling void PM has the capacity to impair early somatic growth and alter early life immune development in a sex specific manner.
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Affiliation(s)
- Ling Chen
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales 2308, Australia; School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania 7000, Australia
| | - Ellen Bennett
- School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania 7000, Australia
| | - Amanda J Wheeler
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania 7000, Australia
| | - A Bruce Lyons
- School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania 7000, Australia
| | - Gregory M Woods
- Cancer and Immunology Research Group, Menzies Research Institute, University of Tasmania, Hobart, Tasmania 7000, Australia
| | - Fay Johnston
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania 7000, Australia
| | - Graeme R Zosky
- School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania 7000, Australia.
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Klevebro S, Westin V, Stoltz Sjöström E, Norman M, Domellöf M, Edstedt Bonamy AK, Hallberg B. Early energy and protein intakes and associations with growth, BPD, and ROP in extremely preterm infants. Clin Nutr 2018; 38:1289-1295. [PMID: 29885776 DOI: 10.1016/j.clnu.2018.05.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 04/03/2018] [Accepted: 05/21/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIM Extremely preterm infants face substantial neonatal morbidity. Nutrition is important to promote optimal growth and organ development in order to reduce late neonatal complications. The aim of this study was to examine the associations of early nutritional intakes on growth and risks of bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) in a high-risk population. METHODS This population-based cohort study includes infants born before 27 0/7 weeks of gestational age without severe malformations and surviving ≥10 days. Intake of energy and protein on postnatal days 4-6 and association with weight standard deviation score (WSDS) from birth to day 7, as well as intakes of energy and protein on postnatal days 4-6 and 7 to 27, respectively, and association with composite outcome of death and BPD and separate outcomes of BPD and ROP were examined, and adjusted for potential confounders. RESULTS The cohort comprised 296 infants with a median gestational age of 25 3/7 weeks. Expressed as daily intakes, every additional 10 kcal/kg/d of energy during days 4-6 was associated with 0.08 higher WSDS on day 7 (95% CI 0.06-0.11; p < 0.001). Between days 7 and 27, every 10 kcal/kg/d increase in energy intake was associated with a reduced risk of BPD of 9% (95% CI 1-16; p = 0.029) and any grade of ROP with a reduced risk of 6% (95% CI 2-9; p = 0.005) in multivariable models. This association was statistically significant in infants with ≤10 days of mechanical ventilation. In infants with >10 days of mechanical ventilation, a combined higher intake of energy and protein was associated with a reduced risk of BPD. CONCLUSION Early provision of energy and protein may reduce postnatal weight loss and risk of morbidity in extremely preterm infants.
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Affiliation(s)
- Susanna Klevebro
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden.
| | - Vera Westin
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Function Area Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden
| | | | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Anna-Karin Edstedt Bonamy
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden; Department of Women's and Children's Health and Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Boubou Hallberg
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
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Duarte ED, Tavares TS, Nishimoto CLJ, Azevedo VMGDO, Silva BCNE, Silva JBD. Questionário para identificação de crianças com condições crônicas (QuICCC-R): tradução e adaptação. ACTA PAUL ENFERM 2018. [DOI: 10.1590/1982-0194201800022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Realizar a tradução e adaptação cultural do Questionnaire for Identifying Children With Chronic Conditions-Revised (QuICCC-R, publicado em 1999) para a língua portuguesa do Brasil. O questionário foi desenvolvido para identificar crianças com condições crônicas por meio da aplicação, aos seus pais ou responsável, de 16 questões sobre as repercussões dessas condições, como limitações funcionais, dependência de mecanismos compensatórios ou de cuidados e utilização de serviços acima do esperado para a idade. O método utilizado é independente de diagnósticos. A aplicação do questionário pode ser feita pessoalmente ou por telefone, com duração média de 2 minutos. Métodos Estudo metodológico, realizado nas seguintes etapas: tradução, tradução reversa, revisão por especialistas 1, pré-teste, revisão por especialistas 2 e cálculo do índice de validade de conteúdo. Resultados O questionário foi traduzido e adaptado para português garantindo a equivalência semântica, idiomática e cultural. O pré-teste e a validação de conteúdo por comitê (índice 0,99) possibilitaram aperfeiçoar o instrumento para aplicação e compreensão pela população alvo. Conclusão Por ser um instrumento de rápida e fácil aplicação, o questionário pode contribuir para identificação da condição crônica na infância, na prática clínica e em estudos epidemiológicos, subsidiando o planejamento em saúde.
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Linke AC, Wild C, Zubiaurre-Elorza L, Herzmann C, Duffy H, Han VK, Lee DSC, Cusack R. Disruption to functional networks in neonates with perinatal brain injury predicts motor skills at 8 months. NEUROIMAGE-CLINICAL 2018; 18:399-406. [PMID: 29487797 PMCID: PMC5816024 DOI: 10.1016/j.nicl.2018.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/15/2018] [Accepted: 02/02/2018] [Indexed: 11/19/2022]
Abstract
Objective Functional connectivity magnetic resonance imaging (fcMRI) of neonates with perinatal brain injury could improve prediction of motor impairment before symptoms manifest, and establish how early brain organization relates to subsequent development. This cohort study is the first to describe and quantitatively assess functional brain networks and their relation to later motor skills in neonates with a diverse range of perinatal brain injuries. Methods Infants (n = 65, included in final analyses: n = 53) were recruited from the neonatal intensive care unit (NICU) and were stratified based on their age at birth (premature vs. term), and on whether neuropathology was diagnosed from structural MRI. Functional brain networks and a measure of disruption to functional connectivity were obtained from 14 min of fcMRI acquired during natural sleep at term-equivalent age. Results Disruption to connectivity of the somatomotor and frontoparietal executive networks predicted motor impairment at 4 and 8 months. This disruption in functional connectivity was not found to be driven by differences between clinical groups, or by any of the specific measures we captured to describe the clinical course. Conclusion fcMRI was predictive over and above other clinical measures available at discharge from the NICU, including structural MRI. Motor learning was affected by disruption to somatomotor networks, but also frontoparietal executive networks, which supports the functional importance of these networks in early development. Disruption to these two networks might be best addressed by distinct intervention strategies.
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Affiliation(s)
- Annika C Linke
- Brain and Mind Institute, Western University, London, Canada; Brain Development Imaging Lab, San Diego State University, San Diego, USA.
| | - Conor Wild
- Brain and Mind Institute, Western University, London, Canada
| | | | | | - Hester Duffy
- Brain and Mind Institute, Western University, London, Canada
| | - Victor K Han
- Children's Health Research Institute, London, Canada.
| | - David S C Lee
- Children's Health Research Institute, London, Canada.
| | - Rhodri Cusack
- Brain and Mind Institute, Western University, London, Canada; Children's Health Research Institute, London, Canada; Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
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van den Berg J, Lööf Åström J, Olofsson J, Fridlund M, Farooqi A. Peripherally inserted central catheter in extremely preterm infants: Characteristics and influencing factors. J Neonatal Perinatal Med 2017; 10:63-70. [PMID: 28304314 DOI: 10.3233/npm-16105] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the duration of catheter stay, incidence of non-elective removal and rates of complications associated with peripherally inserted central catheters (PICCs) in relation to different catheter positions in extremely preterm infants (EPT, <28 weeks of gestation). METHODS A retrospective analysis of Peripherally Inserted Central Catheters (PICCs) inserted in EPT infants over a 10-year period, from January 2004 through December 2013 (mean gestational age, 25.2 weeks; mean birth weight, 727 g). RESULTS Of the 379 PICCs analyzed, the majority of lines (68%) were placed in the central position, and 259 PICCs (56%) were removed electively after fulfilment of the treatment. Significantly more PICCs in the lower extremities compared to the upper extremities were in central positions (86% vs 61%, p < 0.001, respectively). Significantly more PICCs that were removed electively after fulfilment of the treatment were in a central position compared to a non-central position (p < 0.001). Of the 166 catheters that were removed because of complications, most (71%) of them had mechanical problems, and 13% had sepsis resulting in an incidence rate of 4.4/1000 catheter days. CONCLUSION PICCs inserted in the lower extremity were more likely to have a centrally placed tip position compared to PICC lines inserted in the upper extremities.
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Koller-Smith LI, Shah PS, Ye XY, Sjörs G, Wang YA, Chow SSW, Darlow BA, Lee SK, Håkanson S, Lui K. Comparing very low birth weight versus very low gestation cohort methods for outcome analysis of high risk preterm infants. BMC Pediatr 2017; 17:166. [PMID: 28709451 PMCID: PMC5512978 DOI: 10.1186/s12887-017-0921-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 07/05/2017] [Indexed: 11/10/2022] Open
Abstract
Background Compared to very low gestational age (<32 weeks, VLGA) cohorts, very low birth weight (<1500 g; VLBW) cohorts are more prone to selection bias toward small-for-gestational age (SGA) infants, which may impact upon the validity of data for benchmarking purposes. Method Data from all VLGA or VLBW infants admitted in the 3 Networks between 2008 and 2011 were used. Two-thirds of each network cohort was randomly selected to develop prediction models for mortality and composite adverse outcome (CAO: mortality or cerebral injuries, chronic lung disease, severe retinopathy or necrotizing enterocolitis) and the remaining for internal validation. Areas under the ROC curves (AUC) of the models were compared. Results VLBW cohort (24,335 infants) had twice more SGA infants (20.4% vs. 9.3%) than the VLGA cohort (29,180 infants) and had a higher rate of CAO (36.5% vs. 32.6%). The two models had equal prediction power for mortality and CAO (AUC 0.83), and similarly for all other cross-cohort validations (AUC 0.81–0.85). Neither model performed well for the extremes of birth weight for gestation (<1500 g and ≥32 weeks, AUC 0.50–0.65; ≥1500 g and <32 weeks, AUC 0.60–0.62). Conclusion There was no difference in prediction power for adverse outcome between cohorting VLGA or VLBW despite substantial bias in SGA population. Either cohorting practises are suitable for international benchmarking. Electronic supplementary material The online version of this article (doi:10.1186/s12887-017-0921-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada.,Maternal Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
| | - Xiang Y Ye
- Maternal Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Yueping A Wang
- Faculty of Health Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Sharon S W Chow
- Faculty of Health Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Brian A Darlow
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Shoo K Lee
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada.,Maternal Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Kei Lui
- Faculty of Health Science, University of Technology Sydney, Sydney, NSW, Australia. .,Department of Newborn Care, Royal Hospital for Women, Barker St, Sydney, NSW, 2031, Australia.
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Linsell L, Malouf R, Morris J, Kurinczuk JJ, Marlow N. Risk Factor Models for Neurodevelopmental Outcomes in Children Born Very Preterm or With Very Low Birth Weight: A Systematic Review of Methodology and Reporting. Am J Epidemiol 2017; 185:601-612. [PMID: 28338817 DOI: 10.1093/aje/kww135] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/03/2016] [Indexed: 01/08/2023] Open
Abstract
The prediction of long-term outcomes in surviving infants born very preterm (VPT) or with very low birth weight (VLBW) is necessary to guide clinical management, provide information to parents, and help target and evaluate interventions. There is a large body of literature describing risk factor models for neurodevelopmental outcomes in VPT/VLBW children, yet few, if any, have been developed for use in routine clinical practice or adopted for use in research studies or policy evaluation. We sought to systematically review the methods and reporting of studies that have developed a multivariable risk factor model for neurodevelopment in surviving VPT/VLBW children. We searched the MEDLINE, Embase, and PsycINFO databases from January 1, 1990, to June 1, 2014, and identified 78 studies reporting 222 risk factor models. Most studies presented risk factor analyses that were not intended to be used for prediction, confirming that there is a dearth of specifically designed prognostic modeling studies for long-term outcomes in surviving VPT/VLBW children. We highlight the strengths and weaknesses of the research methodology and reporting to date, and provide recommendations for the design and analysis of future studies seeking to analyze risk prediction or develop prognostic models for VPT/VLBW children.
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Holsti A, Adamsson M, Hägglöf B, Farooqi A, Serenius F. Chronic Conditions and Health Care Needs of Adolescents Born at 23 to 25 Weeks' Gestation. Pediatrics 2017; 139:peds.2016-2215. [PMID: 28108580 DOI: 10.1542/peds.2016-2215] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We examined chronic conditions, functional limitations, and special health care needs in extremely preterm children (EPT; 23-25 weeks' gestation) born between 1992 and 1998 at 2 Swedish tertiary care centers that offered regional and active perinatal care to all live-born EPT infants. METHODS Of 134 surviving EPT children, 132 (98%) were assessed at 10 to 15 years of age alongside 103 term-born controls. Identification of children with functional limitations and special health care needs was based on a questionnaire administered to parents. Categorization of medical diagnoses and developmental disabilities was based on child examinations, medical record reviews, and parent questionnaires. RESULTS In logistic regression analyses adjusting for social risk factors and sex, the EPT children had significantly more chronic conditions than the term-born controls, including functional limitations (64% vs 6%; odds ratio [OR], 15; 95% confidence interval [CI], 6.1-37.2; P < .001), compensatory dependency needs (60% vs 29%; OR, 3.8; 95% CI, 2.2-6.6; P < .001), and services above those routinely required by children (64% vs 25%; OR, 5.4; 95% CI, 3.0-9.6; P < .001). Specific diagnoses and disabilities for the EPT group versus controls included cerebral palsy (9.1% vs 0%; P < .001), asthma (21.2% vs 6.8%; P = 001), IQ < -2 SD (31.1% vs 4.9%; P < .001), poor motor skills without neurosensory impairment (21.9% vs 1.9%; P < .001), and psychiatric conditions (15.2% vs 1.9%; P < .001). CONCLUSIONS Adolescents born EPT have considerable long-term health and educational needs. Few had severe impairments that curtailed major activities of daily life.
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Affiliation(s)
| | | | - Bruno Hägglöf
- Child and Adolescent Psychiatry, Institute of Clinical Sciences, University of Umeå, Umeå, Sweden; and
| | | | - Fredrik Serenius
- Units of Pediatrics and.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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García-Muñoz Rodrigo F, Urquía Martí L, García Hernández JÁ, Figueras Aloy J, García-Alix Pérez A. End-of-Life Care and Survival without Major Brain Damage in Newborns at the Limit of Viability. Neonatology 2017; 111:234-239. [PMID: 27894120 DOI: 10.1159/000452195] [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] [Received: 04/05/2016] [Accepted: 10/03/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The probabilities of survival and survival without major brain damage (MBD) are low in newborns at the limit of viability. Survival without MBD constitutes a major concern for parents and professionals. OBJECTIVES To know the probabilities of survival without MBD in newborns ≤26 weeks' gestational age (GA) relative to the total number of survivors, whether these probabilities vary with GA, and how end-of-life (EoL) decisions influence these results. METHODS We included all live-inborn patients of 22-26 weeks' GA, without major congenital anomalies, born in collaborating centers of the Spanish SEN1500 Network (2004-2010). MBD was defined as the presence of severe intraventricular hemorrhage and/or periventricular leukomalacia. RESULTS A total of 3,371 patients were born alive, 3,236 of whom were admitted to the neonatal intensive care unit (NICU). Survival without MBD was 44.4% among patients admitted to the NICU, increasing from 12.5% at 22 weeks to 57.9% at 26 weeks' GA. The proportion of survivors without MBD relative to the total number of survivors was 81.1%, and it was independent of GA. EoL decisions preceded one-third of all deaths and were more frequent among the most immature patients. CONCLUSIONS The proportion of survivors without MBD, when referred to the total number of survivors, is relatively high and is independent of GA. EoL decisions after the occurrence of MBD seem to play an important role in this respect. These results support the attitude of "giving an opportunity" even to the most immature patients, if this is in accordance with the parents' wishes.
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Affiliation(s)
- Fermín García-Muñoz Rodrigo
- Division of Neonatology, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
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Korkmaz L, Baştuğ O, Daar G, Korkut S, Özdemir A, Adnan Öztürk M, Güneş T, Kurtoğlu S. The effects of thyroid function on retinopathy of prematurity. J Neonatal Perinatal Med 2016; 9:349-356. [PMID: 28009339 DOI: 10.3233/npm-915150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess whether TSH and fT4 have a role in the angiogenesis of vaso-obliteration and neovascularization which are the basic pathophysiology of ROP. METHODS In this retrospective case-control study, the control group (n = 56) included preterm newborns with risk for ROP while the laser group (n = 63) was recruited from cases who developed severe neovascularization and needed laser photocoagulation therapy. Considering the first (vaso-obliteration) and second (neovascularization) phases of the disease, in this study we researched the distribution of thyroid function tests between groups. RESULTS With regard to the first phase of the disease, TSH and fT4 showed no significant differences between the control and laser groups accordingly (P > 0.05). Likewise, in the second phase of ROP, there was no significant difference between the control and laser groups with respect to TSH and fT4 levels (P > 0.05). CONCLUSION We found that between the study groups, the levels of thyroid function tests did not have any significant differences, either in the first or the second phases of ROP which are the principal pathophysiology of the disease. Therefore, it was concluded that thyroid hormone values were not informative markers in the course of the disease in preterm babies at risk of developing ROP.
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Affiliation(s)
- Levent Korkmaz
- Division of Neonatology, Department of Pediatrics, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Osman Baştuğ
- Division of Neonatology, Department of Pediatrics, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Ghaniya Daar
- Bozok University, Faculty of Medicine, Department of Pediatrics, Yozgat, Turkey
| | - Sabriye Korkut
- Division of Neonatology, Department of Pediatrics, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Ahmet Özdemir
- Division of Neonatology, Department of Pediatrics, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Mehmet Adnan Öztürk
- Division of Neonatology, Department of Pediatrics, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Tamer Güneş
- Division of Neonatology, Department of Pediatrics, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Selim Kurtoğlu
- Division of Neonatology, Department of Pediatrics, Erciyes University Medical Faculty, Kayseri, Turkey.,Division of Pediatric Endocrinology, Erciyes University Medical Faculty, Kayseri, Turkey
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Andersson AK, Martin L, Strand Brodd K, Almqvist L. Predictors for everyday functioning in preschool children born preterm and at term. Early Hum Dev 2016; 103:147-153. [PMID: 27685465 DOI: 10.1016/j.earlhumdev.2016.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 09/08/2016] [Accepted: 09/17/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Anna Karin Andersson
- School of Health, Care and Welfare, Mälardalen University, Box 883, SE 721 23 Västerås, Sweden.
| | - Lene Martin
- School of Health, Care and Welfare, Mälardalen University, Drottninggatan 16A, SE 632 20, Eskilstuna, Sweden.
| | - Katarina Strand Brodd
- Centre for Clinical Research Sörmland, Uppsala University, Kungsgatan 41, SE 631 48, Eskilstuna, Sweden.
| | - Lena Almqvist
- School of Health, Care and Welfare, Mälardalen University, Box 883, SE 721 23 Västerås, Sweden.
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Holsti A, Adamsson M, Serenius F, Hägglöf B, Farooqi A. Two-thirds of adolescents who received active perinatal care after extremely preterm birth had mild or no disabilities. Acta Paediatr 2016; 105:1288-1297. [PMID: 27275954 DOI: 10.1111/apa.13499] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 03/27/2016] [Accepted: 06/07/2016] [Indexed: 11/27/2022]
Abstract
AIM Active perinatal care (APC) increases the survival of extremely preterm (EPT) infants, but may increase the rate of disabilities. We examined neurodevelopmental outcomes in adolescents aged 10-15 years who were born EPT and received APC in two Swedish tertiary care centres. METHODS Cognitive function was assessed using the Wechsler Intelligence Scale for Children, and neurosensory impairments were assessed by reviewing the case records and a standard parent health questionnaire. The outcomes were compared to term-born controls. RESULTS We assessed 132 EPT adolescents and 103 controls. The rates of cerebral palsy, moderate to severe visual impairment and moderate to severe hearing impairment were 9%, 4% and 6%, respectively, for the EPT children and zero for the controls. Serious cognitive impairment was present in 31% of the EPT adolescents and 5% of the controls. Combining impairments across domains showed that 34% of EPT adolescents had moderate and severe disabilities compared with 5% of the controls. Impairments were more common at 23-24 weeks of gestational age (43%) than at 25 weeks (28.4%). CONCLUSION Two-thirds (66%) of adolescents born EPT who received APC had mild or no disabilities. Our results are relevant for healthcare providers and clinicians counselling families.
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Affiliation(s)
- A Holsti
- Institute of Clinical Sciences; Department of Pediatrics; University of Umeå; Umeå Sweden
| | - M Adamsson
- Institute of Clinical Sciences; Department of Pediatrics; University of Umeå; Umeå Sweden
| | - F Serenius
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - B Hägglöf
- Institute of Clinical Sciences, Child and Adolescent Psychiatry; University of Umeå; Umeå Sweden
| | - A Farooqi
- Institute of Clinical Sciences; Department of Pediatrics; University of Umeå; Umeå Sweden
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31
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Sehr kleine Frühgeborene an der Grenze der Lebensfähigkeit. Monatsschr Kinderheilkd 2016. [DOI: 10.1007/s00112-016-0122-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kuban KCK, Joseph RM, O’Shea TM, Allred EN, Heeren T, Douglass L, Stafstrom CE, Jara H, Frazier JA, Hirtz D, Leviton A. Girls and Boys Born before 28 Weeks Gestation: Risks of Cognitive, Behavioral, and Neurologic Outcomes at Age 10 Years. J Pediatr 2016; 173:69-75.e1. [PMID: 27004675 PMCID: PMC4884461 DOI: 10.1016/j.jpeds.2016.02.048] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/29/2016] [Accepted: 02/18/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To compare the prevalence of cognitive, neurologic, and behavioral outcomes at 10 years of age in 428 girls and 446 boys who were born extremely preterm. STUDY DESIGN A total of 889 of 966 eligible children previously enrolled in the multicenter Extremely Low Gestational Age Newborns Study from 2002-2004 were evaluated at 10 years of age. Children underwent a neuropsychological battery and testing for autism spectrum disorder (ASD), and parents reported on their child's behavior, development, and seizures. RESULTS Of the children, 28% of boys and 21% of girls exhibited moderate to severe impairment on summary measures of cognitive abilities. Boys had a higher prevalence of impairment than girls in nearly all measures of cognition, were more than twice as likely to have microcephaly (15% in boys, 8% in girls), and require more often assistive devices to ambulate (6% in boys, 4% in girls). In contrast, boys and girls had comparable risk for a history of seizure (identified in 10% of the cohort) or epilepsy (identified in 7% of the cohort). The boy-to-girl ratio of ASD (9% in boys, 5% in girls) was lower than expected compared with the overall US autism population. CONCLUSIONS In this contemporary cohort of children born extremely premature and evaluated at school age, boys had higher prevalence of cognitive, neurologic, and behavioral deficits than girls. The ratio of boys to girls among those with ASD deserves further study as does the perinatal environmental-genetic interactions that might contribute to male preponderance of deficits in this high-risk sample.
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Affiliation(s)
- Karl C. K. Kuban
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | - Robert M. Joseph
- Department of Anatomy and Neurobiology, Boston University, Boston, MA
| | - Thomas M. O’Shea
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina, Chapel Hill, NC
| | - Elizabeth N. Allred
- Department of Neurology, Harvard Medical School, Boston, MA, USA,Department of Neurology, Neuroepidemiology Unit, Boston Children’s Hospital, Boston, MA, USA
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Laurie Douglass
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | - Carl E. Stafstrom
- Division of Pediatric Neurology, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD
| | - Hernan Jara
- Department of Radiology, Boston Medical Center, Boston University, Boston, USA
| | - Jean A. Frazier
- Department of Psychiatry, UMASS Medical School/ University of Massachusetts Memorial Health Care, Worcester, MA, USA
| | - Deborah Hirtz
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Alan Leviton
- Department of Neurology, Harvard Medical School, Boston, MA, USA,Department of Neurology, Neuroepidemiology Unit, Boston Children’s Hospital, Boston, MA, USA
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Lee JH, Hornik CP, Testoni D, Laughon MM, Cotten CM, Maldonado RS, Belcastro MR, Clark RH, Smith PB. Insulin, Hyperglycemia, and Severe Retinopathy of Prematurity in Extremely Low-Birth-Weight Infants. Am J Perinatol 2016; 33:393-400. [PMID: 26485249 PMCID: PMC4794341 DOI: 10.1055/s-0035-1565999] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study aims to determine the association between hyperglycemia, insulin therapy, and severe retinopathy of prematurity (ROP) in extremely low-birth-weight (ELBW) infants. STUDY DESIGN In this retrospective database study, we included all ELBW infants who were ≤ 32 weeks gestational age (GA). We excluded infants without any ophthalmology evaluation and infants who died before 28 days of life. A multivariable model was constructed to determine the association between hyperglycemia, insulin use, and severe ROP. We defined hyperglycemia as blood glucose (BG) > 180 mg/dL. Covariates were GA, small for GA status, discharge year, sex, Apgar score at 5 minutes, mechanical ventilation, oxygen use, bacteremia, and postnatal steroid exposure. We defined severe ROP as ROP requiring bevacizumab, cryotherapy, laser therapy, or vitrectomy. Sensitivity analysis using BG > 150 mg/dL and > 200 mg/dL was performed. RESULTS A total of 24,548 infants were included; 2,547 (10%) had severe ROP. Hyperglycemia alone was not associated with severe ROP (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.66-1.17). Hyperglycemia and insulin use were not associated with severe ROP (OR, 1.43; 95% CI, 0.91-2.23). BG > 150 mg/dL and insulin use were associated with severe ROP (OR, 1.34; 95% CI, 1.02-1.76). CONCLUSIONS Hyperglycemia alone was not associated with severe ROP in ELBW infants. However, we did observe a possible trend between the use of insulin and severe ROP.
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Affiliation(s)
- Jan Hau Lee
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Christoph P Hornik
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Daniela Testoni
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Matthew M Laughon
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | - C Michael Cotten
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Ramiro S Maldonado
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | | | - Reese H Clark
- Pediatrix Medical Group, MEDNAX, Inc., Jacksonville, Florida
| | - P Brian Smith
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
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Jeschke E, Biermann A, Günster C, Böhler T, Heller G, Hummler HD, Bührer C. Mortality and Major Morbidity of Very-Low-Birth-Weight Infants in Germany 2008-2012: A Report Based on Administrative Data. Front Pediatr 2016; 4:23. [PMID: 27047906 PMCID: PMC4801886 DOI: 10.3389/fped.2016.00023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/08/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Expectant parents of very preterm infants, physicians, and policy makers require estimates for chances of survival and survival without morbidity. Such estimates should derive from a large, reliable, and contemporary data base of easily available items known at birth. OBJECTIVE To determine short-term outcome and risk factors in very-low-birth-weight preterm infants based on administrative data. METHODS Anonymized routine data sets transmitted from hospital administrations to statutory health insurance companies were used to assess survival and survival free of major morbidities in a large cohort of preterm infants in Germany. RESULTS After exclusion of infants with lethal malformations, there were 13,147 infants with a birth weight below 1,500 g admitted to neonatal care 2008-2012, of whom 1,432 infants (10.9%) died within 180 days. Estimated 180 days survival probabilities were 0.632 (95% confidence interval 0.583-0.677) for infants with 250-499 g birth weight, 0.817 (0.799-0.834) for 500-749 g, 0.931 (0.920-0.940) for 750-999 g, 0.973 (0.967-0.979) for 1,000-1,249 g, and 0.985 (0.981-0.988) for 1,250-1,499 g. Estimated probabilities for survival without major morbidity (surgically treated intraventricular hemorrhage, necrotizing enterocolitis, intestinal perforation, or retinopathy) were 0.433 (0.384-0.481) for 250-499 g, 0.622 (0.600-0.643) for 500-749 g, 0.836 (0.821-0.849) for 750-999 g, 0.938 (0.928-0.946) for 1,000-1,249 g, and 0.969 (0.964-0.974) for 1,250-1,499 g, respectively. Prediction of survival and survival without major morbidities was moderately improved by adding sex, small for gestational age, and severe or moderate congenital malformation, increasing receiver operating characteristic areas under the curve from 0.839 (0.827-0.850) to 0.862 (0.852-0.874) (survival) and from 0.827 (0.822-0.842) to 0.852 (0.846-0.863) (survival without major morbidities), respectively. CONCLUSION The present analysis encourages attempts to use administrative data to investigate the association between risk factors and outcome in preterm infants.
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Affiliation(s)
- Elke Jeschke
- Wissenschaftliches Institut der Ortskrankenkassen , Berlin , Germany
| | | | - Christian Günster
- Wissenschaftliches Institut der Ortskrankenkassen , Berlin , Germany
| | - Thomas Böhler
- Medizinischer Dienst der Krankenkassen Baden-Württemberg , Karlsruhe , Germany
| | - Günther Heller
- Institut für Qualität und Transparenz im Gesundheitswesen , Berlin , Germany
| | - Helmut D Hummler
- Section Neonatology/Pediatric Intensive Care, Ulm University Children's Hospital , Ulm , Germany
| | - Christoph Bührer
- Department of Neonatology, Charité University Medical Center , Berlin , Germany
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Naumburg E, Axelsson I, Huber D, Söderström L. Some neonatal risk factors for adult pulmonary arterial hypertension remain unknown. Acta Paediatr 2015; 104:1104-8. [PMID: 26346500 DOI: 10.1111/apa.13205] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 06/08/2015] [Accepted: 09/03/2015] [Indexed: 10/23/2022]
Abstract
AIM Pulmonary hypertension has been linked to premature birth, chronic lung disease, bronchopulmonary dysplasia and congenital heart disease. This national population-based registry study assessed the risk of adult pulmonary hypertension following premature birth, adjusted for known risk factors. METHODS We focused on adults in the Swedish Pulmonary Arterial Hypertension Registry, who were born prematurely, and controls randomly selected from the Swedish medical birth register and matched to each case by birth year and delivery hospital. Information on perinatal factors was also retrieved from the medical birth register. Conditional multiple logistic regression was used to evaluate the association between premature birth and adult pulmonary hypertension, taking into account the potential confounding factors. RESULTS The study population comprised 427 adults born between 1973 and 1996, with 61 cases and 366 controls. Adult pulmonary hypertension was associated with premature birth, with an odds ratio of 3.08 and 95% confidence interval of 1.21-7.87. The association did not alter after adjusting for potential confounders. CONCLUSION By adjusting for factors linked to adult pulmonary hypertension, namely congenital heart defects, pulmonary diseases and premature birth, we were able to show that other unknown factors may influence the risk for pulmonary hypertension among adults who were born premature.
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Affiliation(s)
- Estelle Naumburg
- Department of Clinical Science; Paediatrics; Umeå University; Umeå Sweden
- Unit of Research, Education and Development; Östersund Hospital; Östersund Sweden
| | | | - Daniel Huber
- Unit of Research, Education and Development; Östersund Hospital; Östersund Sweden
| | - Lars Söderström
- Unit of Research, Education and Development; Östersund Hospital; Östersund Sweden
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Schmidt B, Roberts RS, Davis PG, Doyle LW, Asztalos EV, Opie G, Bairam A, Solimano A, Arnon S, Sauve RS, Cairnie J, Dix J, Adams BA, Warriner E, Marie Kim MH, Anderson P, Davis P, Doyle L, Argus B, Callanan C, Davis N, Duff J, McDonald M, Asztalos E, Hohn D, Lacy M, Haslam R, Barnett C, Goodchild L, Lontis RM, Fraser S, Keng J, Saunders K, Opie G, Kelly E, Woods H, Marchant E, Turner AM, Davis N, Magrath E, Williamson A, Bairam A, Bélanger S, Fraser A, Blayney M, Lemyre B, Frank J, Solimano A, Synnes A, Grunau RE, Hubber-Richard P, Rogers M, Mackay M, Petrie-Thomas J, Butt A, van Wassenaer A, Nuytemans D, Houtzager B, van Sonderen L, Regev R, Itzchack N, Arnon S, Chalaf A, Ohlsson A, O'Brien K, Hamilton AM, Chan ML, Sankaran K, Proctor P, Golan A, Goldsch-Lerman E, Reynolds G, Dromgool B, Meskell S, Parr V, Maher C, Broom M, Kecskes Z, Ringland C, McMillan D, Spellen E, Sauve RS, Christianson H, Anseeuw-Deeks D, Creighton D, Heath J, Alvaro R, Chiu A, Porter C, Turner G, Moddemann D, Granke N, Penner K, Bow J, Mulder A, Wassenberg R, van der Hoeven M, Clarke M, Parfitt J, Parker K, Nwaesei C, Ryan H, Saunders C, Schulze A, Wermuth I, Hilgendorff A, Flemmer AW, Herlenius E, Legnevall L, Lagercrantz H, Matthew D, Amos W, Tulsiani S, Tan-Dy C, Turner M, Phelan C, Shinwell ES, Levine M, Juster-Reicher A, Khairy M, Grier P, Vachon J, Perepolkin L, Barrington KJ, Sinha SK, Tin W, Fritz S, Walti H, Royer D, Halliday H, Millar D, Mayes C, McCusker C, McLaughlin O, Fahnenstich H, Tillmann B, Weber P, Wariyar U, Embleton N, Swamy R, Bucher HU, Fauchere JC, Dietz V, Harikumar C, Tin W, Fritz S, Schmidt B, Anderson PJ, Asztalos EV, Barrington KJ, Davis PG, Dewey D, Doyle LW, Grunau RE, Moddemann D, Ohlsson A, Roberts RS, Solimano A, Tin W, Gent M, Fraser W, Hey E, Perlman M, Thorpe K, Gray S, Roberts RS, Chambers C, Costantini L, Yacura W, McGean E, Scapinello L. Prediction of Late Death or Disability at Age 5 Years Using a Count of 3 Neonatal Morbidities in Very Low Birth Weight Infants. J Pediatr 2015; 167:982-6.e2. [PMID: 26318030 DOI: 10.1016/j.jpeds.2015.07.067] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 07/08/2015] [Accepted: 07/30/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate bronchopulmonary dysplasia (BPD), serious brain injury, and severe retinopathy of prematurity (ROP) as predictors of poor long-term outcome in very low birth weight infants. STUDY DESIGN We examined the associations between counts of the 3 morbidities and long-term outcomes in 1514 of 1791 (85%) infants with birth weights of 500-1250 g who were enrolled in the Caffeine for Apnea of Prematurity trial from October 1999, to October 2004, had complete morbidity data, and were alive at 36 weeks postmenstrual age (PMA). BPD was defined as use of supplemental oxygen at 36 weeks PMA. Serious brain injury on cranial ultrasound included grade 3 and 4 hemorrhage, cystic periventricular leucomalacia, porencephalic cysts, or ventriculomegaly of any cause. Poor long-term outcome was death after 36 weeks PMA or survival to 5 years with 1 or more of the following disabilities: motor impairment, cognitive impairment, behavior problems, poor general health, deafness, and blindness. RESULTS BPD, serious brain injury, and severe ROP occurred in 43%, 13%, and 6% of the infants, respectively. Each of the 3 morbidities was similarly and independently correlated with poor 5-year outcome. Rates of death or disability (95% CI) in children with none, any 1, any 2, and all 3 morbidities were 11.2% (9.0%-13.7%), 22.9% (19.6%-26.5%), 43.9% (35.5%-52.6%), and 61.5% (40.6%-79.8%), respectively. CONCLUSIONS In very low birth weight infants who survive to 36 weeks PMA, a count of BPD, serious brain injury, and severe ROP predicts the risk of a late death or survival with disability at 5 years.
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Affiliation(s)
- Barbara Schmidt
- Division of Neonatology, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
| | - Robin S Roberts
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Peter G Davis
- Department of Obstetrics and Gynecology, University of Melbourne and The Royal Women's Hospital, Melbourne, Victoria, Australia; Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Lex W Doyle
- Department of Obstetrics and Gynecology, University of Melbourne and The Royal Women's Hospital, Melbourne, Victoria, Australia; Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | | | | | - Aida Bairam
- Department of Pediatrics, Laval University, Quebec City, Quebec, Canada
| | - Alfonso Solimano
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Shmuel Arnon
- Department of Neonatology, Meir Medical Center, Kfar Saba and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Reginald S Sauve
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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Islam JY, Keller RL, Aschner JL, Hartert TV, Moore PE. Understanding the Short- and Long-Term Respiratory Outcomes of Prematurity and Bronchopulmonary Dysplasia. Am J Respir Crit Care Med 2015; 192:134-56. [PMID: 26038806 DOI: 10.1164/rccm.201412-2142pp] [Citation(s) in RCA: 232] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Bronchopulmonary dysplasia (BPD) is a chronic respiratory disease associated with premature birth that primarily affects infants born at less than 28 weeks' gestational age. BPD is the most common serious complication experienced by premature infants, with more than 8,000 newly diagnosed infants annually in the United States alone. In light of the increasing numbers of preterm survivors with BPD, improving the current state of knowledge of long-term respiratory morbidity for infants with BPD is a priority. We undertook a comprehensive review of the published literature to analyze and consolidate current knowledge of the effects of BPD that are recognized at specific stages of life, including infancy, childhood, and adulthood. In this review, we discuss both the short-term and long-term respiratory outcomes of individuals diagnosed as infants with the disease and highlight the gaps in knowledge needed to improve early and lifelong management of these patients.
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Affiliation(s)
- Jessica Y Islam
- 1 Center for Asthma Research, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
| | - Roberta L Keller
- 2 Division of Neonatology, Department of Pediatrics, University of California San Francisco, San Francisco, California; and
| | - Judy L Aschner
- 3 Department of Pediatrics and.,4 Department of Obstetrics, Gynecology, and Women's Health, Albert Einstein College of Medicine and the Children's Hospital at Montefiore, Bronx, New York
| | - Tina V Hartert
- 1 Center for Asthma Research, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
| | - Paul E Moore
- 1 Center for Asthma Research, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and.,5 Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
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Sassá AH, Gaíva MAM, Higarashi IH, Marcon SS. Nursing actions in homecare to extremely low birth weight infant. ACTA PAUL ENFERM 2014. [DOI: 10.1590/1982-0194201400080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To describe nursing actions implemented in a home context for the needs presented by the families of extremely low birth weight newborns. Methods This convergent care research was carried out with nine families who were visited in their home. For data collection we used semi-structured informal interviews and observation of participants during the first six months after hospital discharge. Data were analyzed using the thematic modality. Results Care needs of families during daily home care were related mainly to doubts and insecurities specific to extremely low birth weight premature babies and the care and guidance required for follow-up of newborns in general. Conclusion Nursing actions in a home context involve child evaluation, guidance, demonstrations, clarifications, referrals, and stimulation for puericulture follow-up with specialists. These actions also include facilitating family empowerment and gradual autonomy of care.
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Rodrigo FGM, Pérez AGA, Hernández JG, Aloy JF. Morbidity and mortality in newborns at the limit of viability in Spain: A population-based study. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.anpede.2013.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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García-Muñoz Rodrigo F, García-Alix Pérez A, García Hernández JA, Figueras Aloy J. Morbimortalidad en recién nacidos al límite de la viabilidad en España: estudio de base poblacional. An Pediatr (Barc) 2014; 80:348-56. [PMID: 24560497 DOI: 10.1016/j.anpedi.2013.12.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 12/15/2013] [Accepted: 12/20/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- F García-Muñoz Rodrigo
- Servicio de Neonatología, Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España.
| | | | - J A García Hernández
- Servicio de Ginecología y Obstetricia, Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
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The growth of very-low-birth-weight infants at 5 years old in Taiwan. Pediatr Neonatol 2014; 55:114-9. [PMID: 24126010 DOI: 10.1016/j.pedneo.2013.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 10/12/2012] [Accepted: 08/27/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The goal of this study was to compare the growth and effect of growth on cognitive performance at 5 years of age of a group of very-low-birth-weight (VLBW) infants and a group of healthy full-term infants. METHODS Beginning in 1995, under the sponsorship of the Premature Baby Foundation, the Society of Neonatology, Taiwan, conducted a multicenter follow-up study of VLBW infants in Taiwan. The study enrolled 322 VLBW infants and 103 controls for assessment of growth data and cognitive performance at several time points from birth through to 5 years of age. Growth data were assessed with measurements of weight, height, and head circumference taken at the ages of 6 months, 12 months, 24 months, and 60 months. Cognitive performance was assessed at the age of 5 years. The VLBW infants were regarded as "failed" if a measurement was 2 standard deviations below the mean measurement of the control group. Neonatal and perinatal data had been collected prospectively as part of a longitudinal study. Cognitive performance was assessed using the Chinese version of the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-R). RESULTS From 6 months to 5 years, VLBW infants had lower weight, height, and head circumference than the controls. Two hundred twenty-four VLBW infants (69.6%) returned for assessment at 5 years old. Of the 224 VLBW infants, complete sets of measurements of weight, height, and head circumference were obtained for 126 cases (56.3%), 127 cases (56.7%), and 106 cases (47.3%), respectively. Of these, 13 patients (10.3%) failed in weight, 11 patients (8.7%) failed in height, and 17 patients (16.0%) failed in head circumference at the age of 5 years. The mean WPPSI-R scores at the age of 5 years for VLBW children were: 94.1 ± 16.4 (performance IQ), 87.2 ± 12.8 (verbal IQ), and 89.5 ± 14.6 (full IQ). All of these values were also lower than those of the control group, with the differences being statistically significant (p < 0.05). The WPPSI-R scores of VLBW children who failed in head circumference were notably lower than those of VLBW children whose head circumference had caught up with that of their peers. CONCLUSION The growth of VLBW infants was lower than that of healthy full-term infants through 5 years of age. The cognitive performance for VLBW children was also decreased compared to that of the control group, and there was an association between slower growth and decreased cognitive ability.
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Kistner A, Sigurdsson J, Niklasson A, Löfqvist C, Hall K, Hellström A. Neonatal IGF-1/IGFBP-1 axis and retinopathy of prematurity are associated with increased blood pressure in preterm children. Acta Paediatr 2014; 103:149-56. [PMID: 24148095 PMCID: PMC4253130 DOI: 10.1111/apa.12478] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 10/09/2013] [Accepted: 10/17/2013] [Indexed: 01/26/2023]
Abstract
Aim Preterm children are at risk of developing increased blood pressure (BP). We evaluated possible associations between BP, early insulin-like growth factor-1 (IGF-1) and IGF-binding protein-1 (IGFBP-1) levels and retinopathy of prematurity (ROP) in preterm children. Methods The study included 32 infants: median gestational age 28.1 weeks (range 24.6–31.3) and birthweight standard deviation scores (SDS) (±SD) 1.0 ± 2.7. IGF-1 and IGFBP-1 at postnatal weeks 32.6–34.6 and ROP stages were established after birth. BP was measured at the age of 4 years. The ratio (IGF-1)2/IGFBP-1 was created to investigate the influence of both IGF-1 and IGFBP-1 to later BP. Results Diastolic BP correlated with IGFBP-1, inversely correlated with IGF-1 and IGF-12/IGFBP-1 (r = −0.71, p < 0.0001) and positively correlated with catch-up growth velocity from lowest weight SDS to age 36.5 weeks (r = 0.48, p < 0.01), independent of gestational age. Children with moderate-to-severe ROP as neonates had higher mean arterial BP [78 (±95%CI 74–83) vs 71 (±95%CI 68–75) mm Hg, p < 0.05] adjusted for gestational age and birthweight SDS compared to children diagnosed with no to mild ROP. Conclusion Low neonatal IGF-12/IGFBP-1 and severe ROP were associated with higher BP in 4-year-old children born very preterm and may thus predict future cardiovascular morbidity.
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Affiliation(s)
- Anna Kistner
- The Sahlgrenska Center for Pediatric Ophthalmology Research Institute of Neuroscience and Physiology Gothenburg Sweden
- Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden
| | - Jon Sigurdsson
- The Sahlgrenska Center for Pediatric Ophthalmology Research Institute of Neuroscience and Physiology Gothenburg Sweden
| | - Aimon Niklasson
- Department of Pediatrics Institute of Clinical Sciences Sahlgrenska Academy at University of Gothenburg Gothenburg Sweden
| | - Chatarina Löfqvist
- The Sahlgrenska Center for Pediatric Ophthalmology Research Institute of Neuroscience and Physiology Gothenburg Sweden
| | - Kerstin Hall
- Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden
| | - Ann Hellström
- The Sahlgrenska Center for Pediatric Ophthalmology Research Institute of Neuroscience and Physiology Gothenburg Sweden
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Wang LW, Lin YC, Wang ST, Yeh TF, Huang CC. Hypoxic/ischemic and infectious events have cumulative effects on the risk of cerebral palsy in very-low-birth-weight preterm infants. Neonatology 2014; 106:209-15. [PMID: 25012626 DOI: 10.1159/000362782] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 04/10/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hypoxia/ischemia and inflammation are two major mechanisms for cerebral palsy (CP) in preterm infants. OBJECTIVE To investigate whether hypoxia/ischemia- and infection-related events in the perinatal and neonatal periods had cumulative effects on CP risk in very-low-birth-weight (VLBW) premature infants. METHODS From 1995 to 2005, 5,807 VLBW preterm infants admitted to Taiwan hospitals were enrolled. The cumulative effects of hypoxic/ischemic and infectious events during the perinatal and neonatal periods on CP risk at corrected age 24 months were analyzed. RESULTS Of the 4,355 infants with 24-month follow-up, 457 (10.5%) had CP. The CP group had significantly higher incidences of hypoxia/ischemia-related events in the perinatal and neonatal periods, and sepsis in the neonatal period than the normal group. Three hypoxic/ischemic events, including birth cardiopulmonary resuscitation (OR 2.25; 95% CI 1.81-2.82), patent ductus arteriosus (PDA) ligation (2.94; 1.35-5.75) and chronic lung disease (3.14; 2.61-3.85) had the most significant contribution to CP. Relative to CP risk for infants with neither the three hypoxic/ischemic events nor sepsis, the CP odds increased 1.98-, 2.26- and 2.15-fold for infants with birth cardiopulmonary resuscitation, PDA ligation and chronic lung disease, respectively; while the combination with sepsis further increased the odds to 3.18-, 3.83- and 3.25-fold, respectively. Using the three hypoxic/ischemic events plus sepsis, CP rates were 10.0, 16.7, 26.7, 40.0 and 54.7% for infants with none, one, two, three and four events, respectively. CONCLUSIONS Hypoxic/ischemic and infectious events across the perinatal and neonatal periods exerted cumulative effects on CP risk in VLBW premature infants.
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Affiliation(s)
- Lan-Wan Wang
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan, ROC
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Abstract
The immature retinas of preterm neonates are susceptible to insults that disrupt neurovascular growth, leading to retinopathy of prematurity. Suppression of growth factors due to hyperoxia and loss of the maternal-fetal interaction result in an arrest of retinal vascularisation (phase 1). Subsequently, the increasingly metabolically active, yet poorly vascularised, retina becomes hypoxic, stimulating growth factor-induced vasoproliferation (phase 2), which can cause retinal detachment. In very premature infants, controlled oxygen administration reduces but does not eliminate retinopathy of prematurity. Identification and control of factors that contribute to development of retinopathy of prematurity is essential to prevent progression to severe sight-threatening disease and to limit comorbidities with which the disease shares modifiable risk factors. Strategies to prevent retinopathy of prematurity will depend on optimisation of oxygen saturation, nutrition, and normalisation of concentrations of essential factors such as insulin-like growth factor 1 and ω-3 polyunsaturated fatty acids, as well as curbing of the effects of infection and inflammation to promote normal growth and limit suppression of neurovascular development.
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Affiliation(s)
- Ann Hellström
- Department of Ophthalmology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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Lundgren P, Stoltz Sjöström E, Domellöf M, Källen K, Holmström G, Hård AL, Smith LE, Löfqvist C, Hellström A. WINROP identifies severe retinopathy of prematurity at an early stage in a nation-based cohort of extremely preterm infants. PLoS One 2013; 8:e73256. [PMID: 24069180 PMCID: PMC3771982 DOI: 10.1371/journal.pone.0073256] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 07/17/2013] [Indexed: 12/16/2022] Open
Abstract
Objective To evaluate the ability of a postnatal weight-gain algorithm (WINROP) to identify sight-threatening retinopathy of prematurity (ROP type 1) in a nation-based extremely preterm infant cohort. Methods This study enrolled all 707 live-born extremely preterm (gestational age [GA] <27 weeks) infants, born 2004–2007 in Sweden; the Extremely preterm Infants in Sweden Study (EXPRESS). WINROP analysis was performed retrospectively in 407 of the infants using weekly weight gain to assess the preterm infant’s risk of developing ROP type 1 requiring treatment. GA, birthweight (BW), and weekly postnatal weight measurements were entered into WINROP. WINROP signals with an alarm to indicate if the preterm infant is at risk for ROP type 1. Results In this extremely preterm population, WINROP correctly identified 96% (45/47) of the infants who required treatment for ROP type 1. The median time from alarm to treatment was 9 weeks (range, 4–20 weeks). Conclusions WINROP, an online surveillance system using weekly weight gain, identified extremely preterm infants at risk for ROP type 1 requiring treatment at an early stage and with high sensitivity in a Swedish nation-based cohort.
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Affiliation(s)
- Pia Lundgren
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | | | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Karin Källen
- Tornbladsinstitute, Lund University Hospital, Lund, Sweden
| | - Gerd Holmström
- Department of Neuroscience, Ophthalmology, Uppsala University, Uppsala, Sweden
| | - Anna-Lena Hård
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Lois E. Smith
- Department of Ophthalmology, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Chatarina Löfqvist
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ann Hellström
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Case-Smith J, Frolek Clark GJ, Schlabach TL. Systematic Review of Interventions Used in Occupational Therapy to Promote Motor Performance for Children Ages Birth–5 Years. Am J Occup Ther 2013; 67:413-24. [DOI: 10.5014/ajot.2013.005959] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
We examined the research evidence for interventions used in occupational therapy to promote the motor performance of young children ages 0–5 yr. We identified 24 trials, Levels I–III, that met our review criteria. The studies fell into three categories: (1) developmental interventions for infants (ages 0–3 yr), (2) interventions for young children with or at risk for cerebral palsy (CP), and (3) visual–motor interventions for preschool children (ages 3–5 yr). Developmental interventions showed low positive short-term effects with limited evidence for long-term effects, and findings on the benefits of neurodevelopmental treatment were inconclusive. Interventions using specific protocols for children with CP resulted in positive effects. Visual–motor interventions for children with developmental delays (ages 3–5 yr) resulted in short-term effects on children’s visual–motor performance. Of the intervention approaches used in occupational therapy, those that embed behavioral and learning principles appear to show positive effects.
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Affiliation(s)
- Jane Case-Smith
- Jane Case-Smith, EdD, OTR/L, FAOTA, is Professor and Director, Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, 406 Atwell Hall, 453 West 10th Avenue, Columbus, OH 43210;
| | | | - Theresa L. Schlabach
- Theresa L. Schlabach, PhD, OTR/L, BCP, is Professor, Master of Occupational Therapy Department, St. Ambrose University, Davenport, IA, and Private Practitioner in early intervention, State of Illinois
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Melo AMC, Kassar SB, Lira PIC, Coutinho SB, Eickmann SH, Lima MC. Characteristics and factors associated with health care in children younger than 1 year with very low birth weight. J Pediatr (Rio J) 2013; 89:75-82. [PMID: 23544814 DOI: 10.1016/j.jped.2013.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Accepted: 07/25/2012] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To identify the characteristics of health care in infants with very low birth weight during the first year of life and the factors associated with this care. METHODS This was a descriptive study with an analytical component conducted in the city of Maceió, Northeastern Brazil, with a sample of 53 children with a median age of five months at the time of the interview, and their mothers. The mothers were interviewed at home regarding socioeconomic and demographic data and health care provided for the child. Health care was assessed through an index using 16 variables related to the recommended actions for this type of care. RESULTS Multivariate linear regression analysis showed that maternal education and family income were the variables that best explained the health care index variation (18.9%), followed by parity (6.6%), and breastfeeding at the time of the interview (6.9%). CONCLUSIONS Considering that families with lower socioeconomic status, women with a higher number of children, and women who did not breastfeed were factors associated with poor health care of children born with very low birth weight, these variables should be included in measures of public health planning.
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Affiliation(s)
- Ana M C Melo
- Neonatal Intensive Care Unit, Hospital Universitário Professor Alberto Antunes, Universidade Federal de Alagoas (UFAL), Maceió, AL, Brazil.
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Melo AM, Kassar SB, Lira PI, Coutinho SB, Eickmann SH, Lima MC. Characteristics and Factors Associated with Health Care in Children Younger than 1 Year with Very Low Birth Weight. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2013. [DOI: 10.1016/j.jpedp.2012.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Vaucher YE, Peralta-Carcelen M, Finer NN, Carlo WA, Gantz MG, Walsh MC, Laptook AR, Yoder BA, Faix RG, Das A, Schibler K, Rich W, Newman NS, Vohr BR, Yolton K, Heyne RJ, Wilson-Costello DE, Evans PW, Goldstein RF, Acarregui MJ, Adams-Chapman I, Pappas A, Hintz SR, Poindexter B, Dusick AM, McGowan EC, Ehrenkranz RA, Bodnar A, Bauer CR, Fuller J, O'Shea TM, Myers GJ, Higgins RD. Neurodevelopmental outcomes in the early CPAP and pulse oximetry trial. N Engl J Med 2012; 367:2495-504. [PMID: 23268664 PMCID: PMC4140695 DOI: 10.1056/nejmoa1208506] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Previous results from our trial of early treatment with continuous positive airway pressure (CPAP) versus early surfactant treatment in infants showed no significant difference in the outcome of death or bronchopulmonary dysplasia. A lower (vs. higher) target range of oxygen saturation was associated with a lower rate of severe retinopathy but higher mortality. We now report longer-term results from our prespecified hypotheses. METHODS Using a 2-by-2 factorial design, we randomly assigned infants born between 24 weeks 0 days and 27 weeks 6 days of gestation to early CPAP with a limited ventilation strategy or early surfactant administration and to lower or higher target ranges of oxygen saturation (85 to 89% or 91 to 95%). The primary composite outcome for the longer-term analysis was death before assessment at 18 to 22 months or neurodevelopmental impairment at 18 to 22 months of corrected age. RESULTS The primary outcome was determined for 1234 of 1316 enrolled infants (93.8%); 990 of the 1058 surviving infants (93.6%) were evaluated at 18 to 22 months of corrected age. Death or neurodevelopmental impairment occurred in 27.9% of the infants in the CPAP group (173 of 621 infants), versus 29.9% of those in the surfactant group (183 of 613) (relative risk, 0.93; 95% confidence interval [CI], 0.78 to 1.10; P=0.38), and in 30.2% of the infants in the lower-oxygen-saturation group (185 of 612), versus 27.5% of those in the higher-oxygen-saturation group (171 of 622) (relative risk, 1.12; 95% CI, 0.94 to 1.32; P=0.21). Mortality was increased with the lower-oxygen-saturation target (22.1%, vs. 18.2% with the higher-oxygen-saturation target; relative risk, 1.25; 95% CI, 1.00 to 1.55; P=0.046). CONCLUSIONS We found no significant differences in the composite outcome of death or neurodevelopmental impairment among extremely premature infants randomly assigned to early CPAP or early surfactant administration and to a lower or higher target range of oxygen saturation. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Heart, Lung, and Blood Institute; SUPPORT ClinicalTrials.gov number, NCT00233324.).
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Affiliation(s)
- Yvonne E Vaucher
- Department of Pediatrics, University of California at San Diego, San Diego, California 92013, USA
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