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Menegolla MP, Silveira RC, Görgen ARH, Gandolfi FE, Procianoy RS. Antibiotics and beyond: Unraveling the dynamics of bronchopulmonary dysplasia in very preterm infants. Pediatr Pulmonol 2024. [PMID: 39023342 DOI: 10.1002/ppul.27182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 06/14/2024] [Accepted: 07/10/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) remains a significant challenge in neonatal care. Prenatal inflammation and neonatal sepsis contribute to the multifactorial nature of BPD. A potential association between empirical antibiotic therapy and BPD risk has been proposed due to microbiota dysbiosis in very low birth weight premature infants. METHODS A single centered retrospective cohort study of preterm infants (24-32 weeks gestation) from 2014 to 2021. The study compared groups that received empirical antibiotics in the first days of life and those that did not receive any antibiotic in the first days of life. The primary outcomes studied were BPD, death, and the combined outcome of BPD/death. Statistical analysis employed t-tests, Mann-Whitney U, Chi-square, and logistic regression. RESULTS Of 454 preterm infants, 61.5% received antibiotics. This group had lower gestational age, birth weight, and Apgar scores. Antibiotic use was associated with higher incidence of BPD (35.5% vs. 10.3%), death (21.5% vs. 8.6%), and combined outcomes (54.5% vs. 18.3%). In multivariate analysis, antibiotic use independently associated with BPD (OR 2.58, p < 0.001) and combined outcome BPD/death (OR 2.06, p < 0.02). Antenatal corticosteroids provided protection against BPD, but not mortality. CONCLUSION This study suggests an association between early empirical antibiotic use and BPD in preterm infants, emphasizing the need for judicious antibiotic practices in neonatal care.
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Affiliation(s)
- Marina P Menegolla
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Newborn Section, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Rita C Silveira
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Newborn Section, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Antônio R H Görgen
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Newborn Section, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Fernanda E Gandolfi
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Newborn Section, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Renato S Procianoy
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Newborn Section, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Isayama T, Miyakoshi K, Namba F, Hida M, Morioka I, Ishii K, Miyashita S, Uehara S, Kinoshita Y, Suga S, Nakahata K, Uchiyama A, Otsuki K. Survival and unique clinical practices of extremely preterm infants born at 22-23 weeks' gestation in Japan: a national survey. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-326355. [PMID: 38777561 DOI: 10.1136/archdischild-2023-326355] [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: 09/23/2023] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES To investigate prognosis and clinical practices of infants born at 22-23 weeks' gestational age (wkGA) in Japan. DESIGN A national institutional-level electronic questionnaire surveys performed in September 2021. SETTING All perinatal centres across Japan. PATIENTS Infants born at 22-23 wkGA in 2018-2020. MAIN OUTCOME MEASURES Proportion of active resuscitation and survival at neonatal intensive care unit (NICU) discharge, and various clinical practices. RESULTS In total, 255 of 295 NICUs (86%) responded. Among them, 145 took care of infants born at 22-23 wkGA and answered the questions regarding their outcomes and care. In most NICUs (129 of 145 (89%)), infants born at 22+0 wkGA can be actively resuscitated. In almost half of the NICUs (79 of 145 (54%)), infants born at ≥22+0 wkGA were always actively resuscitated. Among 341 and 757 infants born alive at 22 and 23 wkGA, respectively, 85% (291 of 341) and 98% (745 of 757) received active resuscitation after birth. Among infants actively resuscitated at birth, 63% (183 of 291) and 80% (594 of 745) of infants born at 22 and 23 wkGA survived, respectively. The survey revealed unique clinical management for these infants in Japan, including delivery with caul in caesarean section, cut-cord milking after clamping cord, immediate intubation at birth, hydrocortisone use for chronic lung disease, analgesia/sedation use for infants on mechanical ventilation, routine echocardiography and brain ultrasound, probiotics administration, routine glycerin enema and skin dressing to prevent pressure ulcers. CONCLUSIONS Many 22-23 wkGA infants were actively resuscitated in Japan and had a high survival rate. Various unique clinical practices were highlighted.
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Affiliation(s)
- Tetsuya Isayama
- Division of Neonatology, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Kei Miyakoshi
- Obstetrics and Gynecology, International Catholic Hospital, Tokyo, Japan
| | - Fumihiko Namba
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Mariko Hida
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Keisuke Ishii
- Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Susumu Miyashita
- Department of Maternal Fetal Medicine, Miyagi Children's Hospital, Sendai, Miyagi, Japan
| | - Shuichiro Uehara
- Department of Pediatric Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Yoshiaki Kinoshita
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Sachie Suga
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Katsutoshi Nakahata
- Department of Anesthesiology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Atsushi Uchiyama
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Katsufumi Otsuki
- Department of Obstetrics and Gynecology, Showa University Koto Toyosu Hospital, Koto-ku, Tokyo, Japan
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Shoukat A, Abdollahi E, Galvani AP, Halperin SA, Langley JM, Moghadas SM. Cost-effectiveness analysis of nirsevimab and maternal RSVpreF vaccine strategies for prevention of Respiratory Syncytial Virus disease among infants in Canada: a simulation study. LANCET REGIONAL HEALTH. AMERICAS 2023; 28:100629. [PMID: 38026446 PMCID: PMC10663690 DOI: 10.1016/j.lana.2023.100629] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023]
Abstract
Background The cost-effectiveness of immunisation strategies with a long-acting monoclonal antibody (nirsevimab) and/or a protein-based maternal vaccine (RSVpreF) for protecting infants from Respiratory Syncytial Virus (RSV)-associated illness has not been previously determined for Canada. We estimated the health benefits and cost-effectiveness of nirsevimab for immunising the entire birth cohort, regardless of gestational age or other risk factors. Additionally, we evaluated the health benefits and cost-effectiveness of a combined strategy of year-round vaccination of pregnant women with RSVpreF and immunisation of infants at high risk, including those born preterm or with chronic conditions, with nirsevimab during the RSV season. Methods We developed a discrete-event simulation model, parameterized with the data on medically-attended RSV infections among infants under one year of age from 2010 to 2019, including outpatient care, hospitalisations, and deaths. Intervention scenarios targeting twelve monthly birth cohorts and pregnant women, reflecting the 2021 census data for Ontario, Canada were evaluated over a follow-up time horizon of one year from birth. Taking into account the costs (in 2023 Canadian dollars) associated with RSV-related outcomes, we calculated the net monetary benefit using the quality-adjusted life-year (QALY) gained. Further, we determined the range of price-per-dose (PPD) for nirsevimab and RSVpreF within which the program was cost-effective. Cost-effectiveness analyses were conducted from both healthcare and societal perspectives. Findings Using a willingness-to-pay of CAD$50,000 per QALY gained, we found that immunising the entire birth cohort with nirsevimab would be cost-effective from a societal perspective for a PPD of up to $290, with an annual budget impact of $83,978 for 1113 infants per 100,000 population. An alternative, combined strategy of vaccinating pregnant women and immunising only infants at high risk of severe disease would lead to a lower budget impact of $49,473 per 100,000 population with a PPD of $290 and $195 for nirsevimab and RSVpreF vaccine, respectively. This combined strategy would reduce infant mortality by 76%-85%, comparable to a 78% reduction achieved through a nirsevimab-only program of the entire birth cohort. The PPD for cost-effective programs with nirsevimab was sensitive to the target population among infants. Interpretation Passive immunisation of infants under 6 months of age with nirsevimab and vaccination of pregnant women with RSVpreF could be a cost-effective strategy for protecting infants during their first RSV season. Funding This study was supported by the Canadian Immunisation Research Network (CIRN) and the Canadian Institutes of Health Research (CIHR). Seyed M. Moghadas acknowledges support from the Natural Sciences and Engineering Research Council of Canada (MfPH and Discovery grants). Alison P. Galvani acknowledges support from the The Notsew Orm Sands Foundation.
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Affiliation(s)
- Affan Shoukat
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada
| | - Elaheh Abdollahi
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT, USA
| | - Alison P. Galvani
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT, USA
| | - Scott A. Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Joanne M. Langley
- Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Seyed M. Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada
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Tanaka K, Hayashi R, Ariyama Y, Takahashi N, Namba F. Management of bronchopulmonary dysplasia in Japan: A nationwide survey. Early Hum Dev 2023; 186:105867. [PMID: 37788509 DOI: 10.1016/j.earlhumdev.2023.105867] [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: 08/10/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND The incidence of bronchopulmonary dysplasia (BPD) and respiratory management practices for extremely low birth weight infants (ELBWIs) widely vary among institutions and countries. AIMS To clarify the variation and characteristics of the current practices of Japanese neonatologists managing patients with BPD. STUDY DESIGN Questionnaire-based survey. PARTICIPANTS Level II and III perinatal centers certified by the Japan Society of Perinatal and Neonatal Medicine. OUTCOME MEASURES Policies of the neonatal intensive care units (NICUs) regarding respiratory care and medications for BPD prevention and treatment. RESULTS A total of 76 % of facilities (207/274) responded to our survey. The response rates of level III and II facilities were 91 % (102/112) and 35 % (105/296), respectively. INtubation-SURfactant-Extubation and Less Invasive Surfactant Administration methods were performed in 23 % (47/206) and 1 % (3/206) of facilities, respectively. For the prophylactic purpose, systemic and inhaled steroids were administered "frequently" or "occasionally" in 14 % (28/205) and 42 % (86/204) of NICUs, respectively. For the therapeutic purpose, systemic and inhaled steroids were administered "frequently" or "occasionally" in 84 % (171/204) and 29 % (59/204) of NICUs, respectively. Approximately half of the NICUs (99/202) used volume-targeted ventilation (VTV) "frequently" or "occasionally" in progressing BPD. High-frequency oscillation ventilation (HFOV) was used for progressing BPD "frequently" and "occasionally" in 89 % (180/202) of the facilities. CONCLUSIONS Our study provided an overview and characteristics of BPD management in Japan in recent years. Noninvasive approaches with surfactant administration remain not widely used in Japan. HFOV is a widely accepted management for progressing BPD.
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Affiliation(s)
- Kosuke Tanaka
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.
| | - Ryo Hayashi
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Yuta Ariyama
- Department of Neonatology, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Naoto Takahashi
- Department of Pediatrics, The University of Tokyo Hospital, Bunkyo, Tokyo, Japan
| | - Fumihiko Namba
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
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Zhang Z, Lou X, Hua L, Jia X, Xu L, Zhao M. Cardiopulmonary Ultrasound-Guided Treatment of Premature Infants with Respiratory Failure and Patent Ductus Arteriosus: A Randomized, Controlled Trial. Indian J Pediatr 2023; 90:1103-1109. [PMID: 36952111 DOI: 10.1007/s12098-023-04489-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/11/2022] [Accepted: 12/09/2022] [Indexed: 03/24/2023]
Abstract
OBJECTIVES To evaluate the role of cardiopulmonary ultrasonography in the treatment of preterm infants with respiratory failure combined with patent ductus arteriosus (PDA). METHODS A single-center, prospective, randomized, controlled trial of premature infants born in the authors' hospital with a birth weight ≤ 1500 g and respiratory failure combined with PDA was conducted from January 2020 to December 2021. The included infants were randomly assigned to the cardiopulmonary ultrasound-guided therapy group or the traditional therapy group. The primary outcome of this study was data on respiratory support and PDA. RESULTS A total of 76 premature infants were included in the study. There were 39 patients in the cardiopulmonary ultrasound-guided therapy group and 37 patients in the traditional therapy group. There was no difference in the baseline data, and the cardiopulmonary ultrasound-guided therapy group had a higher initial positive end-expiratory pressure [difference in median = -1.5 cm H2O, 95% confidence interval (CI): -2.0 to -1.0, p < 0.0001], earlier use of ibuprofen to close the PDA (difference in median = 2.5 d, 95% CI: 1.0-4.0, p = 0.004), fewer patients requiring invasive respiratory support [risk ratio (RR) = 0.63, 95% CI: 0.41-0.99, p = 0.04], and a lower incidence of moderate to severe bronchopulmonary dysplasia (RR = 0.44, 95% CI: 0.44-0.96, p = 0.04). There was no difference in the incidence of adverse events. CONCLUSIONS For premature infants with respiratory failure combined with PDA, cardiopulmonary ultrasonography can better guide respiratory support. The timely administration of drugs helps treat PDA, thereby decreasing the risk of intubation and BPD. TRIAL REGISTRATION https://www.trialos.com/index/ , TRN: 20220420024607012, date of registration: 2022/03/28, retrospectively registered.
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Affiliation(s)
- Zhiqun Zhang
- The Fourth Clinical College, Zhejiang University of Traditional Chinese Medicine, Hangzhou, China.
- Department of Neonatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261 Huansha Road, Hangzhou, China.
| | - Xinrui Lou
- The Fourth Clinical College, Zhejiang University of Traditional Chinese Medicine, Hangzhou, China
| | - Luyi Hua
- The Fourth Clinical College, Zhejiang University of Traditional Chinese Medicine, Hangzhou, China
| | - Xinhui Jia
- The Fourth Clinical College, Zhejiang University of Traditional Chinese Medicine, Hangzhou, China
| | - Lili Xu
- Department of Neonatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261 Huansha Road, Hangzhou, China
| | - Min Zhao
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Yu Z, Wang L, Wang Y, Zhang M, Xu Y, Liu A. Development and Validation of a Risk Scoring Tool for Bronchopulmonary Dysplasia in Preterm Infants Based on a Systematic Review and Meta-Analysis. Healthcare (Basel) 2023; 11:healthcare11050778. [PMID: 36900783 PMCID: PMC10000930 DOI: 10.3390/healthcare11050778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023] Open
Abstract
Background: Bronchopulmonary dysplasia (BPD) is the most common serious pulmonary morbidity in preterm infants with high disability and mortality rates. Early identification and treatment of BPD is critical. Objective: This study aimed to develop and validate a risk scoring tool for early identification of preterm infants that are at high-risk for developing BPD. Methods: The derivation cohort was derived from a systematic review and meta-analysis of risk factors for BPD. The statistically significant risk factors with their corresponding odds ratios were utilized to construct a logistic regression risk prediction model. By scoring the weights of each risk factor, a risk scoring tool was established and the risk stratification was divided. External verification was carried out by a validation cohort from China. Results: Approximately 83,034 preterm infants with gestational age < 32 weeks and/or birth weight < 1500 g were screened in this meta-analysis, and the cumulative incidence of BPD was about 30.37%. The nine predictors of this model were Chorioamnionitis, Gestational age, Birth weight, Sex, Small for gestational age, 5 min Apgar score, Delivery room intubation, and Surfactant and Respiratory distress syndrome. Based on the weight of each risk factor, we translated it into a simple clinical scoring tool with a total score ranging from 0 to 64. External validation showed that the tool had good discrimination, the area under the curve was 0.907, and that the Hosmer-Lemeshow test showed a good fit (p = 0.3572). In addition, the results of the calibration curve and decision curve analysis suggested that the tool showed significant conformity and net benefit. When the optimal cut-off value was 25.5, the sensitivity and specificity were 0.897 and 0.873, respectively. The resulting risk scoring tool classified the population of preterm infants into low-risk, low-intermediate, high-intermediate, and high-risk groups. This BPD risk scoring tool is suitable for preterm infants with gestational age < 32 weeks and/or birth weight < 1500 g. Conclusions: An effective risk prediction scoring tool based on a systematic review and meta-analysis was developed and validated. This simple tool may play an important role in establishing a screening strategy for BPD in preterm infants and potentially guide early intervention.
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Affiliation(s)
- Zhumei Yu
- Department of Neonatology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
- School of Nursing, Anhui Medical University, Hefei 230032, China
| | - Lili Wang
- Department of Neonatology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Yang Wang
- Department of Neonatology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Min Zhang
- Department of Neonatology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Yanqin Xu
- Department of Neonatology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Annuo Liu
- School of Nursing, Anhui Medical University, Hefei 230032, China
- Correspondence:
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Abstract
While cyclooxygenase inhibitors have been the most common medications used to facilitate earlier closure of patent ductus arteriosus in preterm infants, adverse effects and low efficacy in extremely low gestational age neonates (ELGANs) have highlighted a need for alternative options. Combination therapy with acetaminophen and ibuprofen is a novel strategy for PDA treatment in ELGANs, as it may facilitate higher ductal closure rates via additive action on two separate pathways inhibiting prostaglandin production. Initial small observational studies and pilot randomized clinical trials indicate potentially higher efficacy of the combination regime to induce ductal closure in comparison to treatment with ibuprofen alone. In this review, we examine the potential clinical impact of treatment failure in ELGANs with significant PDA, highlight the biological rationale in support of studying combination therapy, and review the randomized and non-randomized studies to date. With the rising number of ELGANs receiving neonatal intensive care, who are vulnerable to PDA-related morbidities, there is an urgent need for adequately powered clinical trials to systematically investigate the efficacy and safety of combination therapy for PDA treatment.
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Affiliation(s)
- Bonny Jasani
- Division of Neonatology, Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Dany E Weisz
- Department of Pediatrics, University of Toronto, Toronto, Canada; Department of Newborn and Developmental Pediatrics, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Jeff Reese
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amish Jain
- Department of Pediatrics, University of Toronto, Toronto, Canada; Department of Pediatrics, Mount Sinai Hospital, Toronto, Canada.
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Okulu E, Kraja E, Kostekci YE, Aloyeva R, Erdeve O, Atasay B, Arsan S. Comparison of Definitions for Bronchopulmonary Dysplasia: A Cohort Study. Z Geburtshilfe Neonatol 2023; 227:58-63. [PMID: 36070784 DOI: 10.1055/a-1915-5682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
We aimed to compare the definitions of National Institute of Child Health and Human Development (NICHD) for bronchopulmonary dysplasia (BPD) for determining the incidences, and predicting late death and respiratory outcome. This retrospective cohort study included infants born at<32 weeks' gestation who survived up to 36 weeks' postmenstrual age (PMA). Infants were classified as having BPD or no BPD per thedefinitions of NICHD 2001 and 2018. The incidences of BPD were 49 and 32% according to the 2001 and 2018 NICHD definitions. Gestational age, birth weight and intubation after birth were associated with BPD by both definitions. The NICHD 2018 definition displayed similar sensitivity (100%) and negative predictive value (100%), and higher specificity (70 vs. 52%) for predicting death after 36 weeks' PMA; a higher specificity (72 vs. 53%), comparable negative predictive value (77 vs.76%), but lower sensitivity for predicting adverse respiratory outcome within 12 months corrected age compared with the NICHD 2001 definition. The NICHD 2018 definition is as powerful as the 2001 definition for predicting late death and seems to be a better indicator for long-term respiratory outcome. The use of supplemental oxygen or oxygen plus respiratory support should be considered while predicting both late death and long-term respiratory outcome.
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Affiliation(s)
- Emel Okulu
- Department of Pediatrics, Division of Neonatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Elvis Kraja
- Department of Pediatrics, Division of Neonatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Yasemin Ezgi Kostekci
- Department of Pediatrics, Division of Neonatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Rana Aloyeva
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Omer Erdeve
- Department of Pediatrics, Division of Neonatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Begum Atasay
- Department of Pediatrics, Division of Neonatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Saadet Arsan
- Department of Pediatrics, Division of Neonatology, Ankara University Faculty of Medicine, Ankara, Turkey
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Tomo CK, Balogun OO, Davidson J, Guinsburg R, Almeida MFBD, Lopes JMDA, Barros MCDM, Takehara K, Mikami M, Isayama T, Hoshino A, Mori R, Mizuguchi M. Comparison of mortality and survival without major morbidities of very preterm infants with very low birth weight from Japan and Brazil. REVISTA PAULISTA DE PEDIATRIA 2023; 41:e2021389. [PMID: 36102406 PMCID: PMC9462411 DOI: 10.1590/1984-0462/2023/41/2021389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/13/2022] [Indexed: 11/22/2022]
Abstract
Objective: This study was carried out to understand the disparities in mortality and survival without major morbidities among very premature and very low birth weight infants between participating Neonatal Intensive Care Units (NICUs) from the Brazilian Network on Neonatal Research (RBPN) and the Neonatal Research Network of Japan (NRNJ). Methods: Secondary data analysis of surveys by the RBPN and NRNJ was performed. The surveys were conducted in 2014 and 2015 and included 187 NICUs. Primary outcome was mortality or survival without any major morbidity. Logistic regression analysis adjustment for confounding factors was used. Results: The study population consisted of 6,406 infants from the NRNJ and 2,319 from the RBPN. Controlling for various confounders, infants from RBPN had 9.06 times higher adjusted odds of mortality (95%CI 7.30–11.29), and lower odds of survival without major morbidities (AOR 0.36; 95%CI 0.32–0.41) compared with those from the NRNJ. Factors associated with higher odds of mortality among Brazilian NICUs included: Air Leak Syndrome (AOR 4.73; 95%CI 1.26–15.27), Necrotizing Enterocolitis (AOR 3.25; 95%CI 1.38–7.26), and Late Onset Sepsis (LOS) (AOR 4.86; 95%CI 2.25–10.97). Conclusions: Very premature and very low birth weight infants from Brazil had significantly higher odds for mortality and lower odds for survival without major morbidities in comparison to those from Japan. Additionally, we identified the factors that increased the odds of in-hospital neonatal death in Brazil, most of which was related to LOS.
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Affiliation(s)
- Caroline Kaori Tomo
- University of Tokyo, Japan; National Center for Child Health and Development, Japan
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Zenner C, Chalklen L, Adjei H, Dalby MJ, Mitra S, Cornwell E, Shaw AG, Sim K, Kroll JS, Hall LJ. Noninvasive Fecal Cytokine and Microbiota Profiles Predict Commencement of Necrotizing Enterocolitis in a Proof-of-Concept Study. GASTRO HEP ADVANCES 2023; 2:666-675. [PMID: 37469521 PMCID: PMC10352139 DOI: 10.1016/j.gastha.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/01/2023] [Indexed: 07/21/2023]
Abstract
Background and Aims Necrotizing enterocolitis (NEC) is a life-threatening disease and the most common gastrointestinal emergency in premature infants. Accurate early diagnosis is challenging. Modified Bell's staging is routinely used to guide diagnosis, but early diagnostic signs are nonspecific, potentially leading to unobserved disease progression, which is problematic given the often rapid deterioration observed. We investigated fecal cytokine levels, coupled with gut microbiota profiles, as a noninvasive method to discover specific NEC-associated signatures that can be applied as potential diagnostic markers. Methods Premature babies born below 32 weeks of gestation were admitted to the 2-site neonatal intensive care unit (NICU) of Imperial College hospitals (St. Mary's or Queen Charlotte's & Chelsea) between January 2011 and December 2012. During the NICU stay, expert neonatologists grouped individuals by modified Bell's staging (healthy, NEC1, NEC2/3) and fecal samples from diapers were collected consecutively. Microbiota profiles were assessed by 16S rRNA gene amplicon sequencing and cytokine concentrations were measured by V-Plex multiplex assays. Results Early evaluation of microbiota profiles revealed only minor differences. However, at later time points, significant changes in microbiota composition were observed for Bacillota (adj. P = .0396), with Enterococcus being the least abundant in Bell stage 2/3 NEC. Evaluation of fecal cytokine levels revealed significantly higher concentrations of IL-1α (P = .045), IL-5 (P = .0074), and IL-10 (P = .032) in Bell stage 1 NEC compared to healthy individuals. Conclusion Differences in certain fecal cytokine profiles in patients with NEC indicate their potential use as diagnostic biomarkers to facilitate earlier diagnosis. Additionally, associations between microbial and cytokine profiles contribute to improving knowledge about NEC pathogenesis.
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Affiliation(s)
- Christian Zenner
- Intestinal Microbiome, School of Life Sciences, ZIEL – Institute for Food & Health, Technical University of Munich, Freising, Germany
| | - Lisa Chalklen
- Gut Microbes & Health, Quadram Institute Biosciences, Norwich, United Kingdom
| | - Helena Adjei
- Gut Microbes & Health, Quadram Institute Biosciences, Norwich, United Kingdom
| | - Matthew J. Dalby
- Gut Microbes & Health, Quadram Institute Biosciences, Norwich, United Kingdom
| | - Suparna Mitra
- Gut Microbes & Health, Quadram Institute Biosciences, Norwich, United Kingdom
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Emma Cornwell
- Department of Medicine, Section of Paediatric Infectious Disease, Imperial College London, London, United Kingdom
| | - Alexander G. Shaw
- Department of Medicine, Section of Paediatric Infectious Disease, Imperial College London, London, United Kingdom
| | - Kathleen Sim
- Department of Medicine, Section of Paediatric Infectious Disease, Imperial College London, London, United Kingdom
| | - J. Simon Kroll
- Department of Medicine, Section of Paediatric Infectious Disease, Imperial College London, London, United Kingdom
| | - Lindsay J. Hall
- Intestinal Microbiome, School of Life Sciences, ZIEL – Institute for Food & Health, Technical University of Munich, Freising, Germany
- Gut Microbes & Health, Quadram Institute Biosciences, Norwich, United Kingdom
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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11
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Nakauchi C, Miyata M, Kamino S, Funato Y, Manabe M, Kojima A, Kawai Y, Uchida H, Fujino M, Boda H. Dexmedetomidine versus fentanyl for sedation in extremely preterm infants. Pediatr Int 2023; 65:e15581. [PMID: 37428855 DOI: 10.1111/ped.15581] [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: 01/29/2023] [Revised: 04/06/2023] [Accepted: 05/23/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Few studies have compared the efficacy and complications of dexmedetomidine (DEX) and fentanyl (FEN) in extremely preterm infants. METHODS We conducted a single-institution, retrospective controlled before and after study of preterm infants before 28 weeks of gestation admitted between April 2010 and December 2018 to compare the complications and efficacy of DEX and FEN for preterm infants. Patients were administered FEN prior to 2015 and DEX after 2015 as the first-line sedative. A composite outcome of death during hospitalization and developmental quotient (DQ) < 70 at a corrected age of 3 years was compared as the primary outcome. Secondary outcomes including postmenstrual weeks at extubation, days of age when full enteral feeding was achieved and additional sedation by phenobarbital (PB) were compared. RESULTS Sixty-six infants were enrolled into the study. The only perinatal factor that differed between the FEN (n = 33) and DEX (n = 33) groups was weeks of gestation. The composite outcome of death and DQ < 70 at a corrected age of 3 years were not significantly different. Postmenstrual weeks at extubation did not significantly differ between groups after adjustment for weeks of gestation and being small for gestational age. On the other hand, full feeding was significantly prolonged by DEX (p = 0.031). Additional sedation was less common in the DEX group (p = 0.044). CONCLUSION The composite outcome of death and DQ < 70 at a corrected age of 3 years were not significantly different by DEX or FEN for primary sedation. Prospective randomized controlled trials should examine the long-term effects on development.
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Affiliation(s)
- Chiharuko Nakauchi
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake City, Japan
| | - Masafumi Miyata
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake City, Japan
| | - Shigemitsu Kamino
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake City, Japan
| | - Yusuke Funato
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake City, Japan
| | - Masahiko Manabe
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake City, Japan
| | - Arisa Kojima
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake City, Japan
| | - Yuri Kawai
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake City, Japan
| | - Hidetoshi Uchida
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake City, Japan
| | - Masayuki Fujino
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake City, Japan
| | - Hiroko Boda
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake City, Japan
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12
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Miyazawa T, Arahori H, Ohnishi S, Shoji H, Matsumoto A, Wada YS, Takahashi N, Takayanagi T, Toishi S, Nagaya K, Hasegawa H, Hayakawa M, Hida M, Fukuhara R, Yamada Y, Kawai M, Takashi K, Wada K, Morioka I, Mizuno K. Mortality and morbidity of extremely low birth weight infants in Japan, 2015. Pediatr Int 2023; 65:e15493. [PMID: 36740921 DOI: 10.1111/ped.15493] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/10/2023] [Accepted: 02/02/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND In Japan, the mortality rate of extremely low birth weight (ELBW) infants is notably low in comparison with other developed countries, but the prevalence of chronic lung disease (CLD) and retinopathy of prematurity (ROP) is relatively high. This study aimed to estimate the mortality and morbidity of ELBW infants born in 2015 who were admitted to neonatal intensive care units (NICUs) in Japan and to examine the factors that affected the short-term outcomes of these infants. We also compared the mortality of ELBW infants born in 2005, 2010, and 2015. METHODS We analyzed the mortality, morbidity, and factors related to short-term outcomes of ELBW infants, using data from 2782 infants born in 2015 and registered at NICUs in Japan. RESULTS The mortality rates during NICU stays were 17.0%, 12.0%, and 9.8% for ELBW infants born in 2005, 2010, and 2015, respectively. Among ELBW infants born in 2015, multiple logistic regression analysis showed that short gestational age and low birthweight Z-score contributed to the increased risk of death. Births by cesarean section and antenatal corticosteroid administration were significantly associated with a reduced risk of death. Among infants who survived, CLD was observed in 53.1% and ROP requiring treatment was observed in 30.4%. CONCLUSIONS Mortality in ELBW infants decreased significantly from 2005 to 2015. As CLD and ROP may affect quality of life and long-term outcomes of infants who survived, prevention strategies and management for these complications are critical issues in neonatal care in Japan.
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Affiliation(s)
- Tokuo Miyazawa
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Hitomi Arahori
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoshi Ohnishi
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hromichi Shoji
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Atsushi Matsumoto
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics, Iwate Medical University School of Medicine, Iwate, Japan
| | - Yuka Sano Wada
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Neonatology, National Center for Child Health and Development, Tokyo, Japan
| | - Naoto Takahashi
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Toshimitsu Takayanagi
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics, National Hospital Organization, Saga National Hospital, Saga, Japan
| | - Satoshi Toishi
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Neonatology, Japanese Red Cross Narita Hospital, Chiba, Japan
| | - Ken Nagaya
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Division of Neonatology, Center for Maternity and Infant Care, Asahikawa Medical University Hospital, Hokkaido, Japan
| | - Hisaya Hasegawa
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Division of Neonatal Intensive Care, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Masahiro Hayakawa
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Mariko Hida
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Rie Fukuhara
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Neonatology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Yasumasa Yamada
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Perinatal and Neonatal Medicine, Aichi Medical University Hospital, Aichi, Japan
| | - Masahiko Kawai
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kusaka Takashi
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Kazuko Wada
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Neonatology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Ichiro Morioka
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Katsumi Mizuno
- The Committee on Neonatal Medicine, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
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13
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Kiatchoosakun P, Jirapradittha J, Paopongsawan P, Techasatian L, Lumbiganon P, Thepsuthammarat K, Sutra S. Mortality and Comorbidities in Extremely Low Birth Weight Thai Infants: A Nationwide Data Analysis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121825. [PMID: 36553269 PMCID: PMC9776691 DOI: 10.3390/children9121825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022]
Abstract
This is the first nationwide study aimed to evaluate in-hospital mortality and comorbidities of extremely low birth weight (ELBW) infants in Thailand between 2015-2020. Data of ELBW infants were collected from the National Health Coverage Scheme. The incidence of ELBW Thai infants was 1.75 per 1000 live births. Sixty-five percent of ELBW infants were delivered in tertiary-care facilities, with 63% surviving until discharge. In-hospital mortality was 36.9%. Non-invasive respiratory supports were documented in just 17.6% of the study population, whereas total parenteral nutrition was used in 52.3% of neonates. There were several comorbidities, with the three most frequent including respiratory distress syndrome (70.7%), neonatal jaundice (66.7%), and sepsis (60.4%). The median hospitalization cost for one ELBW infant who survived was 296,438.40 baht ($8719). Conclusion: Thailand had an acceptable ELBW infant survival rate (63%), but comorbidities remained particularly severe and cost one hundred times the median hospital cost for one ELBW infant that survived in comparison to a normal newborn infant. Better health outcomes require strategies to raise awareness of the issues and the appropriate implementation of evidence-based solutions, particularly improving neonatal care facilities, as well as early referral of high-risk pregnant women and neonates, which will aid in the future reduction of neonatal morbidities and mortalities.
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Affiliation(s)
- Pakaphan Kiatchoosakun
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
- Correspondence: ; Tel.: +66-43-363012
| | - Junya Jirapradittha
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Pongsatorn Paopongsawan
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Leelawadee Techasatian
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Pagakrong Lumbiganon
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Kaewjai Thepsuthammarat
- Clinical Epidemiology Unit, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Sumitr Sutra
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
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14
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Patil M, Vardhelli V, Hagan JL, Deshabhotla S, Murki S. Mortality and Morbidity in Premature Infants: An East and West Comparative Study. Am J Perinatol 2022; 39:1449-1459. [PMID: 33486747 DOI: 10.1055/s-0040-1722654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Survival of preterm infants differs dramatically depending on birthplace. No previous studies have compared outcomes of preterm infants between low middle-income and high-income countries such as India and the United States. The purpose of this study is to evaluate differences in care practices, resources, mortality, and morbidities in preterm infants with birth weight 700 to 1,500 g between two major neonatal centers in these countries. STUDY DESIGN This is a retrospective cohort study with de-identified data from Fernandez Hospital (FH) in Hyderabad, India, and Texas Children's Hospital (TCH) in Houston, TX, for infants born January 2016 to December 2018, and weighing 700 to 1,500 g at birth. The primary outcome was death before hospital discharge. RESULTS Of 1,195 infants, 736 were admitted to FH and 459 were admitted to TCH. After controlling for differences in gestational age, small for gestational age, and antenatal corticosteroid use, TCH patients had lower mortality before hospital discharge (adjusted odds ratio [aOR] = 0.28, 95% confidence interval [CI]: 0.16-0.48, p < 0.001) and more bronchopulmonary dysplasia (BPD; aOR = 2.2, 95% CI: 1.51-3.21, p < 0.001). The composite outcome of death or BPD and death or any major morbidity (BPD or intraventricular hemorrhage grade II or more or periventricular leukomalacia grade II or more or retinopathy of prematurity requiring treatment) were not different. CONCLUSION In this study, TCH infants had decreased odds of death before hospital discharge compared with FH but higher odds of BPD, which may be related to increased survival and differences in care practices. KEY POINTS · Few studies compared outcomes of premature infants between different high-income countries.. · There are no studies comparing preterm infants between low middle-income and high-income countries such as India and the United States.. · This study evaluated detailed comparison of care practices and infrastructure of NICUs in India and United states..
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Affiliation(s)
- Monika Patil
- Department of Pediatrics, Section of Neonatology, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Joseph L Hagan
- Department of Pediatrics, Section of Neonatology, Texas Children's Hospital, Houston, Texas
| | | | - Srinivas Murki
- Department of Neonatology, Fernandez Hospital, Hyderabad, Telangana, India
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15
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Pei X, Gao Y, Kou Y, Ding Y, Li D, Lei P, Zuo L, Liu Q, Miao N, Reddy S, Yu Y, Sun X. Association of necrotizing enterocolitis with antimicrobial exposure in preterm infants <32 weeks gestational age:A multicenter prospective case-control study. Front Pharmacol 2022; 13:976487. [PMID: 36210827 PMCID: PMC9537687 DOI: 10.3389/fphar.2022.976487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: To assess the risk of necrotizing enterocolitis (NEC) and explore the relationship between antibiotic overexposure and disease occurrence in a large prospective birth cohort.Methods: Based on a prospective birth cohort, the study collected hospitalization data of very preterm infants (VPIs) having gestational age of less than 32 weeks from January 1, 2018, to June 30, 2021 via the China Northern Neonatal Network. Infants diagnosed with NEC ≥ stage II were included in the case group, and each case was matched for GA and birth weight for the control group. Furthermore, the risk factors for NEC were determined by statistical analyses.Results: A total of 6425 VPIs were included in this study, and 167 (2.6%) of these subjects were diagnosed with NEC ≥ stage II. The study also included 984 extremely preterm infants (gestational age <28 weeks), including 50 (5.1%) infants diagnosed with NEC ≥ stage II. In the matched case-control study, subjects had a total of antibiotic days-of-therapy for 9015 days, of which broad-spectrum antibiotics (BSAs) accounted for 77%. The antibiotic spectrum index per antibiotic day in the case group was significantly higher and was an independent risk factor for the occurrence of NEC (p = 0.001, OR = 1.13).Conclusion: The cohort of VPIs was overexposed to antiboitics. Unreasonable combination of antibiotics and overexposure to BSAs may increase the risk of NEC in preterm infants.
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Affiliation(s)
- Xiaojing Pei
- Department of Neonatology, Linyi People’s Hospital, Linyi, China
| | - Yujun Gao
- Department of Neonatology, Baogang Third Hospital of Hongci Group, Baotou, China
| | - Yan Kou
- Department of Neonatology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yanjie Ding
- Department of Neonatology, Yantai Yuhuangding Hospital, Yantai, China
| | - Dan Li
- Department of Neonatology, Liaocheng People’s Hospital, Liaocheng, China
| | - Peng Lei
- Department of Neonatology, Jinan Maternity and Child Care Hospital, Jinan, China
| | - Lili Zuo
- Department of Neonatology, Zibo Maternity and Child Care Hospital, Zibo, China
| | - Qiongyu Liu
- Department of Neonatology, Women and Children’s Healthcare Hospital of Linyi, Linyi, China
| | - Naiying Miao
- Department of Neonatology, Hebei Petro China Central Hospital, Hebei, China
| | - Simmy Reddy
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yonghui Yu
- Department of Neonatology, Shandong Provincial Hospital, Shandong University, Jinan, China
- Department of Neonatology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, China
- *Correspondence: Yonghui Yu, ; Xuemei Sun,
| | - Xuemei Sun
- Department of Neonatology, Linyi People’s Hospital, Linyi, China
- *Correspondence: Yonghui Yu, ; Xuemei Sun,
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16
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Jia CH, Feng ZS, Lin XJ, Cui QL, Han SS, Jin Y, Liu GS, Yang CZ, Ye XT, Dai YH, Liang WY, Ye XZ, Mo J, Ding L, Wu BQ, Chen HX, Li CW, Zhang Z, Rong X, Huang WM, Shen W, Yang BY, Lv JF, Huo LY, Huang HW, Rao HP, Yan WK, Yang Y, Ren XJ, Liu D, Wang FF, Diao SG, Liu XY, You CM, Meng Q, Wang B, Zhang LJ, Huang YG, Ao D, Li WZ, Chen JL, Chen YL, Li W, Chen ZF, Ding YQ, Li XY, Huang YF, Lin NY, Cai YF, Wan ZH, Ban Y, Bai B, Li GH, Yan YX, Wu F. Short term outcomes of extremely low birth weight infants from a multicenter cohort study in Guangdong of China. Sci Rep 2022; 12:11119. [PMID: 35778441 PMCID: PMC9249781 DOI: 10.1038/s41598-022-14432-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/07/2022] [Indexed: 02/05/2023] Open
Abstract
With the increase in extremely low birth weight (ELBW) infants, their outcome attracted worldwide attention. However, in China, the related studies are rare. The hospitalized records of ELBW infants discharged from twenty-six neonatal intensive care units in Guangdong Province of China during 2008-2017 were analyzed. A total of 2575 ELBW infants were enrolled and the overall survival rate was 55.11%. From 2008 to 2017, the number of ELBW infants increased rapidly from 91 to 466, and the survival rate improved steadily from 41.76% to 62.02%. Increased survival is closely related to birth weight (BW), regional economic development, and specialized hospital. The incidence of complications was neonatal respiratory distress syndrome (85.2%), oxygen dependency at 28 days (63.7%), retinopathy of prematurity (39.3%), intraventricular hemorrhage (29.4%), necrotizing enterocolitis (12.0%), and periventricular leukomalacia (8.0%). Among the 1156 nonsurvivors, 90.0% of infants died during the neonatal period (≤ 28 days). A total of 768 ELBW infants died after treatment withdrawal, for reasons of economic and/or poor outcome. The number of ELBW infants is increasing in Guangdong Province of China, and the overall survival rate is improving steadily.
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Affiliation(s)
- Chun-Hong Jia
- Department of Pediatrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China
- Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangzhou, 510150, Guangdong, China
| | - Zhou-Shan Feng
- Department of Pediatrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China
| | - Xiao-Jun Lin
- Department of Pediatrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China
| | - Qi-Liang Cui
- Department of Pediatrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China
| | - Sha-Sha Han
- Department of Neonatology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Ya Jin
- Department of Neonatology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Guo-Sheng Liu
- Department of Neonatology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Chuan-Zhong Yang
- Department of Neonatology, Shenzhen Maternal and Child Healthcare Hospital, Affiliated Southern Medical University, Shenzhen, 518028, Guangdong, China
| | - Xiao-Tong Ye
- Department of Neonatology, Shenzhen Maternal and Child Healthcare Hospital, Affiliated Southern Medical University, Shenzhen, 518028, Guangdong, China
| | - Yi-Heng Dai
- Department of Neonatology, Foshan Maternal and Child's Hospital, Foshan, 528000, Guangdong, China
| | - Wei-Yi Liang
- Department of Neonatology, Foshan Maternal and Child's Hospital, Foshan, 528000, Guangdong, China
| | - Xiu-Zhen Ye
- Department of Neonatology, Women and Children Hospital of Guangdong Province, Guangzhou, 510010, Guangdong, China
| | - Jing Mo
- Department of Neonatology, Women and Children Hospital of Guangdong Province, Guangzhou, 510010, Guangdong, China
| | - Lu Ding
- Department of Neonatology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China
| | - Ben-Qing Wu
- Department of Neonatology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China
| | - Hong-Xiang Chen
- Department of Neonatology, Meizhou People's Hospital, Meizhou, 514031, Guangdong, China
| | - Chi-Wang Li
- Department of Neonatology, Meizhou People's Hospital, Meizhou, 514031, Guangdong, China
| | - Zhe Zhang
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou, 510120, Guangdong, China
| | - Xiao Rong
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou, 510120, Guangdong, China
| | - Wei-Min Huang
- Department of Neonatology, Nanfang Hospital of Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Wei Shen
- Department of Neonatology, Nanfang Hospital of Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Bing-Yan Yang
- Department of Neonatology, Boai Hospital of Zhongshan, Zhongshan, 528400, Guangdong, China
| | - Jun-Feng Lv
- Department of Neonatology, Boai Hospital of Zhongshan, Zhongshan, 528400, Guangdong, China
| | - Le-Ying Huo
- Department of Neonatology, Zhuhai Maternity and Child Health Hospital, Zhuhai, 519001, Guangdong, China
| | - Hui-Wen Huang
- Department of Neonatology, Zhuhai Maternity and Child Health Hospital, Zhuhai, 519001, Guangdong, China
| | - Hong-Ping Rao
- Department of Neonatology, Huizhou Municipal Central Hospital, Huizhou, 516001, Guangdong, China
| | - Wen-Kang Yan
- Department of Neonatology, Huizhou Municipal Central Hospital, Huizhou, 516001, Guangdong, China
| | - Yong Yang
- Department of Neonatology, Dongguan Maternity and Child Health Hospital, Dongguan, 523002, Guangdong, China
| | - Xue-Jun Ren
- Department of Neonatology, Dongguan Maternity and Child Health Hospital, Dongguan, 523002, Guangdong, China
| | - Dong Liu
- Department of Neonatology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, 529000, Guangdong, China
| | - Fang-Fang Wang
- Department of Neonatology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, 529000, Guangdong, China
| | - Shi-Guang Diao
- Department of Neonatology, Yuebei People's Hospital, Shaoguan, 512026, Guangdong, China
| | - Xiao-Yan Liu
- Department of Neonatology, Yuebei People's Hospital, Shaoguan, 512026, Guangdong, China
| | - Chu-Ming You
- Department of Neonatology, Guangdong Second Provincial People's Hospital, Guangzhou, 510317, Guangdong, China
| | - Qiong Meng
- Department of Neonatology, Guangdong Second Provincial People's Hospital, Guangzhou, 510317, Guangdong, China
| | - Bin Wang
- Department of Pediatrics, Zhujiang Hospital of Southern Medical University, Guangzhou, 510280, Guangdong, China
| | - Li-Juan Zhang
- Department of Pediatrics, Zhujiang Hospital of Southern Medical University, Guangzhou, 510280, Guangdong, China
| | - Yu-Ge Huang
- Department of Pediatrics, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, Guangdong, China
| | - Dang Ao
- Department of Pediatrics, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, Guangdong, China
| | - Wei-Zhong Li
- Department of Neonatology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Jie-Ling Chen
- Department of Neonatology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Yan-Ling Chen
- Department of Neonatology, Jinan University Medical College Affiliated Dongguan Hospital, Dongguan, 523900, Guangdong, China
| | - Wei Li
- Department of Neonatology, Jinan University Medical College Affiliated Dongguan Hospital, Dongguan, 523900, Guangdong, China
| | - Zhi-Feng Chen
- Department of Pediatrics, Dongguan People's Hospital, Dongguan, 523000, Guangdong, China
| | - Yue-Qin Ding
- Department of Pediatrics, Dongguan People's Hospital, Dongguan, 523000, Guangdong, China
| | - Xiao-Yu Li
- Department of Neonatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Yue-Fang Huang
- Department of Neonatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Ni-Yang Lin
- Department of Neonatology, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Yang-Fan Cai
- Department of Neonatology, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Zhong-He Wan
- Department of Neonatology, Nanhai District People's Hospital of Foshan, Foshan, 528200, Guangdong, China
| | - Yi Ban
- Department of Neonatology, Nanhai District People's Hospital of Foshan, Foshan, 528200, Guangdong, China
| | - Bo Bai
- Department of Neonatology, Huadu District People's Hospital of Guangzhou, Guangzhou, 510800, Guangdong, China
| | - Guang-Hong Li
- Department of Neonatology, Huadu District People's Hospital of Guangzhou, Guangzhou, 510800, Guangdong, China
| | - Yue-Xiu Yan
- Department of Pediatrics, The First People's Hospital of Zhaoqing, Zhaoqing, 526020, Guangdong, China
| | - Fan Wu
- Department of Pediatrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China.
- Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangzhou, 510150, Guangdong, China.
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17
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Gima H, Nakamura T. Association between General Movements Assessment and Later Motor Delay (excluding Cerebral Palsy) in Low-Birth-Weight Infants. Brain Sci 2022; 12:brainsci12060686. [PMID: 35741571 PMCID: PMC9221334 DOI: 10.3390/brainsci12060686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/11/2022] [Accepted: 05/21/2022] [Indexed: 02/04/2023] Open
Abstract
The general movements (GMs) assessment is useful for the prediction of cerebral palsy (CP) and other developmental disorders. Developmental coordination disorder (DCD) is highly prevalent in low-birth-weight (LBW) infants. We investigated the association between aberrant GMs during early infancy and later motor development in LBW infants. The study included infants who fulfilled the following criteria: GMs assessed at 9–20 weeks post-term age; developmental quotient (DQ) assessed at 3 years of age using the Kyoto Scale; intelligence quotient (IQ) assessed at 6 years of age. Participants with normal IQs at 6 years of age without a diagnosis of CP (14 males and 37 females, 23–36 weeks gestation with birth weights of 492–1498 g) were categorized into normal (n = 39) and aberrant (n = 12) groups based on GMs assessment; DQ was compared between the groups. We investigated the items in the DQ assessment and found that the infants in the aberrant group were more frequently unable to perform. Infants in the aberrant group showed a significantly lower DQ in the ‘postural-motor domain’, and were more frequently unable to ‘climb the stairs with alternating legs’ and ‘Jump from a 15–20 cm platform’. This study highlights that GMs aberrancy in early infancy is associated with a delayed gross motor development, even in children with a typical development. The GMs assessment may be useful for the prediction of DCD.
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Affiliation(s)
- Hirotaka Gima
- Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashi-Ogu, Arakawa-ku, Tokyo 116-8551, Japan
- Correspondence: ; Tel.: +81-3-3819-7154
| | - Tomohiko Nakamura
- Department of Neonatology, Nagano Children’s Hospital, 3100, Toyoshina, Azumino City, Nagano 399-8288, Japan;
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18
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Chevallier M, Debillon T, Darlow BA, Synnes AR, Pierrat V, Hurrion E, Yang J, Ego A, Ancel PY, Lui K, Shah PS, Luu TM. Mortality and significant neurosensory impairment in preterm infants: an international comparison. Arch Dis Child Fetal Neonatal Ed 2022; 107:317-323. [PMID: 34509987 DOI: 10.1136/archdischild-2021-322288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/25/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare mortality and rates of significant neurosensory impairment (sNSI) at 18-36 months' corrected age in infants born extremely preterm across three international cohorts. DESIGN Retrospective analysis of prospectively collected neonatal and follow-up data. SETTING Three population-based observational cohort studies: the Australian and New Zealand Neonatal Network (ANZNN), the Canadian Neonatal and Follow-up Networks (CNN/CNFUN) and the French cohort Etude (Epidémiologique sur les Petits Ages Gestationnels: EPIPAGE-2). PATIENTS Extremely preterm neonates of <28 weeks' gestation in year 2011. MAIN OUTCOME MEASURES Primary outcome was composite of mortality or sNSI defined by cerebral palsy with no independent walking, disabling hearing loss and bilateral blindness. RESULTS Overall, 3055 infants (ANZNN n=960, CNN/CNFUN n=1019, EPIPAGE-2 n=1076) were included in the study. Primary composite outcome rates were 21.3%, 20.6% and 28.4%; mortality rates were 18.7%, 17.4% and 26.3%; and rates of sNSI among survivors were 4.3%, 5.3% and 3.3% for ANZNN, CNN/CNFUN and EPIPAGE-2, respectively. Adjusted for gestational age and multiple births, EPIPAGE-2 had higher odds of composite outcome compared with ANZNN (OR 1.71, 95% CI 1.38 to 2.13) and CNN/CNFUN (OR 1.72, 95% CI 1.39 to 2.12). EPIPAGE-2 did have a trend of lower odds of sNDI but far short of compensating for the significant increase in mortality odds. These differences may be related to variations in perinatal approach and practices (and not to differences in infants' baseline characteristics). CONCLUSIONS Composite outcome of mortality or sNSI for extremely preterm infants differed across high-income countries with similar baseline characteristics and access to healthcare.
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Affiliation(s)
- Marie Chevallier
- Neonatal Intensive Care Unit, Grenoble Alps University Hospital Centre Couples and Children Section, Grenoble, France .,TIMC-IMAG Research Department, Grenoble Alps University, Grenoble, France
| | - Thierry Debillon
- Neonatal Intensive Care Unit, Grenoble Alps University Hospital Centre Couples and Children Section, Grenoble, France.,TIMC-IMAG Research Department, Grenoble Alps University, Grenoble, France
| | - Brian A Darlow
- Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
| | - Anne R Synnes
- Department of Neonatology, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Véronique Pierrat
- Obstetrical Perinanal And Pediatric Epidemiology Research team (EPOPé), Center of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris, Île-de-France, France.,Departement of Neonatal medicine, Lille University Hospital, Lille, France
| | - Elizabeth Hurrion
- Department of Newborn Services, Mater Mothers Hospital and Mater Medical Research Institute, South Brisbane, Queensland, Australia
| | - Junmin Yang
- Maternal Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anne Ego
- TIMC-IMAG Research Department, Grenoble Alps University, Grenoble, France.,CIC U1406, INSERM, Grenoble, France.,Department of Public Health, Grenoble Alps University Hospital, Grenoble, France
| | - Pierre Yves Ancel
- Obstetrical Perinanal And Pediatric Epidemiology Research team (EPOPé), Center of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris, Île-de-France, France.,Clinical Investigation center P1419, Paris Public Assistance Hospital, Paris, France
| | - Kei Lui
- Department of Newborn Care, Australian and New Zealand Neonatal Network, Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, University of New South Wales, Sydney, New South Wales, Australia
| | - Prakeshkumar S Shah
- Maternal Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Thuy Mai Luu
- Pediatrics and Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
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19
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Growth Trajectories during the First 6 Years in Survivors Born at Less Than 25 Weeks of Gestation Compared with Those between 25 and 29 Weeks. J Clin Med 2022; 11:jcm11051418. [PMID: 35268509 PMCID: PMC8911231 DOI: 10.3390/jcm11051418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/30/2022] Open
Abstract
We aimed to determine the differences in the growth trajectories of the youngest gestational survivors (<25 weeks’ gestation) up to 6 years of age compared to those of older gestational ages. Preterm infants were divided into two groups: 22−24 weeks’ gestation (male (M) 16, female (F) 28) and 25−29 weeks’ gestation (M 84, F 59). Z-scores of body weight (BW), body length (BL), and body mass index (BMI) were derived from Japanese standards at 1, 1.5, 3, and 6 years of corrected age. Comparisons between the two groups by sex were made using the Wilcoxon test and linear regression analysis to examine the longitudinal and time-point associations of anthropometric z-scores, the presence of small for gestational age (SGA), and the two gestational groups. BW, BL, BMI, and z-scores were significantly lower in the 22−24 weeks group at almost all assessment points. However, there were no significant differences in BW, BL, BMI, and z-scores between the two female groups after 3 years. BMI z-scores were significantly associated with the youngest gestational age and the presence of SGA at all ages in males, but not in females. The youngest gestational age had a greater influence in males on the z-score of anthropometric parameters up to 6 years of age.
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20
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Cao X, Zhang L, Jiang S, Li M, Yan C, Shen C, Yang Y, Lee SK, Cao Y. Epidemiology of necrotizing enterocolitis in preterm infants in China: A multicenter cohort study from 2015 to 2018. J Pediatr Surg 2022; 57:382-386. [PMID: 34175121 DOI: 10.1016/j.jpedsurg.2021.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/23/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To describe the current incidence, case-fatality rate and surgical treatment proportion of necrotizing enterocolitis (NEC) among preterm infants in China. METHODS The study included all live neonates with <34 weeks gestational age (GA) admitted to 25 tertiary hospitals within 7 days of birth from 19 provinces in China between May 2015 and April 2018. NEC was defined as ≥stage II according to Bell's criteria. RESULTS A total of 24,731 infants were included. The overall incidence of NEC was 3.3% and decreased with increasing GA and birth weight. The incidence of NEC was 4.8% in very preterm infants and 1.8% in infants born ≥32 weeks GA, respectively. The overall case-fatality rate of NEC was 9.5%, and the case-fatality rate was 7.0% among infants born ≥32 weeks GA. A total of 214 (27.9%) infants underwent surgery, and their overall case-fatality rate was 13.6%. Significant variation in the incidence of NEC existed among different centers (0.6-11.1%). CONCLUSIONS The incidence and case-fatality rate of NEC are high in China, especially among infants with GA ≥32 weeks, and varies significantly among sites. A high proportion of NEC infants required surgical management, with an even higher case-fatality rate.
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Affiliation(s)
- Xincheng Cao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Lan Zhang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Siyuan Jiang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Mengmeng Li
- Nanjing Maternity and Child Health Care Hospital, Jiangsu, China
| | - Changhong Yan
- Jiangxi Provincial Children's Hospital, Jiangxi, China
| | - Chun Shen
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Yi Yang
- NHC Key Laboratory of Neonatal Disease, Fudan University, Shanghai, China
| | - Shoo K Lee
- Maternal-Infant Care Research Centre and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.
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21
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Ramos-Navarro C, Maderuelo-Rodríguez E, Concheiro-Guisán A, Pérez-Tarazona S, Rueda-Esteban S, Sánchez-Torres A, Sánchez-Solís M, Sanz-López E, Sánchez-Luna M. Risk factors and bronchopulmonary dysplasia severity: data from the Spanish Bronchopulmonary Dysplasia Research Network. Eur J Pediatr 2022; 181:789-799. [PMID: 34596741 DOI: 10.1007/s00431-021-04248-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/12/2021] [Accepted: 08/27/2021] [Indexed: 11/30/2022]
Abstract
GEIDIS is a national-based research-net registry of patients with bronchopulmonary dysplasia (BPD) from public and private Spanish hospitals. It was created to provide data on the clinical characterization and follow-up of infants with BPD until adulthood. The purpose of this observational study was to analyze the characteristics and the impact of perinatal risk factors on BPD severity. The study included 1755 preterm patients diagnosed with BPD. Of the total sample, 90.6% (n = 1591) were less than 30 weeks of gestation. The median gestational age was 27.1 weeks (25.8-28.5) and median birth weight 885 g (740-1,070 g). A total of 52.5% (n = 922) were classified as mild (type 1), 25.3% (n = 444) were moderate (type 2), and 22.2% (n = 389) were severe BPD (type 3). In patients born at under 30 weeks' gestation, most pre-and postnatal risk factors for type 2/3 BPD were associated with the length of exposure to mechanical ventilation (MV). Independent prenatal risk factors were male gender, oligohydramnios, and intrauterine growth restriction. Postnatal risk factors included the need for FiO2 of > 0.30 in the delivery room, nosocomial pneumonia, and the length of exposure to MV. Conclusion: In this national-based research-net registry of BPD patients, the length of MV is the most important risk factor associated with type 2/3 BPD. Among type 3 BPD patients, those who required an FiO2 > .30 at 36 weeks' postmenstrual age had a higher morbidity, during hospitalization and at discharge, compared to those with nasal positive pressure but FiO2 < .30. What is Known: • BPD is a highly complex multifactorial disease associated with preterm birth. What is New: • The length of exposure to mechanical ventilation is the most important postnatal risk factor associated to bronchopulmonary severity which modulate the effect of most pre and postnatal risk factors. • Among patients with BPD, the requirement for FiO2 >.30% at 36 weeks of postmenstrual age is associated with greater morbidity during hospitalization and at discharge.
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Affiliation(s)
- Cristina Ramos-Navarro
- Neonatologist at Neonatology Department, Gregorio Marañón University Hospital, O'Donnell 48 street, 28009, Madrid, Spain.
| | - Elena Maderuelo-Rodríguez
- Neonatologist at Neonatology Department, Gregorio Marañón University Hospital, O'Donnell 48 street, 28009, Madrid, Spain
| | - Ana Concheiro-Guisán
- Neonatologist at Neonatology Department, Álvaro Cunqueiro University Hospital, Vigo, Spain
| | | | - Santiago Rueda-Esteban
- Pediatric Pulmonologist at Pulmonology Department, San Carlos University Hospital, Madrid, Spain
| | - Ana Sánchez-Torres
- Neonatologist at Neonatology Department, La Paz University Hospital, Madrid, Spain
| | - Manuel Sánchez-Solís
- Pediatric Pulmonologist at Pulmonology Department, Virgen Arrixaca University Hospital Murcia, Murcia, Spain
| | - Ester Sanz-López
- Neonatologist at Neonatology Department, Gregorio Marañón University Hospital, O'Donnell 48 street, 28009, Madrid, Spain
| | - Manuel Sánchez-Luna
- Neonatologist at Neonatology Department, Gregorio Marañón University Hospital, O'Donnell 48 street, 28009, Madrid, Spain
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22
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Cuevas Guaman M, Hagan J, Sabic D, Tillman DM, Fernandes CJ. Volume-guarantee vs. pressure-limited ventilation in evolving bronchopulmonary dysplasia. Front Pediatr 2022; 10:952376. [PMID: 36619499 PMCID: PMC9816376 DOI: 10.3389/fped.2022.952376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Extremely premature infants are at high risk for developing bronchopulmonary dysplasia (BPD). While noninvasive support is preferred, they may require ventilator support. Although volume-targeted ventilation (VTV) has been shown to be beneficial in preventing BPD, no data exists to guide ventilator management of infants with evolving BPD. Thus, clinicians employ a host of ventilator strategies, traditionally time-cycled pressure-limited ventilation (PLV) and more recently volume-guarantee ventilation (VGV) (a form of VTV). In this study, we sought to test the hypothesis that use of VGV in evolving BPD is associated with improved clinical and pulmonary outcomes when compared with PLV. DESIGN Single-center, retrospective cohort review of premature infants born less than 28 weeks inborn to a Level 4 NICU from January 2015 to December 2020. Data abstracted included demographics, maternal and birth data, and ventilator data until death or discharge. Exposure to either VGV or PLV was also examined, including ventilator "dose" (number of time points from DOL 14, 21 and 28 the patient was on that particular ventilator) during the period of evolving BPD. RESULTS Of a total of 471 patients with ventilation data available on DOL 14, 268 were not ventilated and 203 were ventilated. PLV at DOL 21 and 28 was associated with significantly higher risk of BPD and the composite outcome of BPD or death before 36 weeks compared to VGV. Both increasing VGV and PLV doses were significantly associated with higher odds of BPD and the composite outcome. For each additional time point of VGV and PLV exposure, the predicted length of stay (LOS) increased by 15.3 days (p < 0.001) and 28.8 days (p < 0.001), respectively. DISCUSSION Our study demonstrates the association of use of VGV at DOL 21 and 28 with decreased risk of BPD compared to use of PLV. Prospective trials are needed to further delineate the most effective ventilatory modality for this population with "evolving" BPD.
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Affiliation(s)
- Milenka Cuevas Guaman
- Department of Pediatrics, Division of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Joseph Hagan
- Department of Pediatrics, Division of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Dajana Sabic
- Department of Pediatrics, Division of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Davlyn M Tillman
- Department of Pediatrics, Division of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Caraciolo J Fernandes
- Department of Pediatrics, Division of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
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23
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Sawada Y, Honda N, Narumiya M, Mizumoto H. Evaluation of the social skills of low birthweight infants using the Interaction Rating Scale. J Phys Ther Sci 2022; 34:697-703. [PMID: 36213188 PMCID: PMC9535250 DOI: 10.1589/jpts.34.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to examine, using the Interaction Rating Scale, the effect of
social skills at 18 months of life on the subsequent development of low birthweight
infants. [Participants and Methods] The study participants were made up of a total of 23
infants who were admitted to the neonatal intensive care unit of Hospital A and whose
developmental indexes were followed up at the outpatient clinic for up to 3 years of age.
The survey was conducted twice in each infant, at a corrected age of 18 months and at 36
full months of age. Social skills and developmental indexes were assessed at the corrected
age of 18 months, meanwhile only developmental indexes were assessed at 36 full months, to
examine associations. The Interaction Rating Scale was used to assess social skills. This
scale measures various aspects of social development by observing caregiver-child
interactions in situations wherein children are engaged in tasks more difficult for their
age. [Results] The results demonstrated that social skills at 18 months were associated
with the developmental indexes at 18 and 36 months, whereas more items were associated
with the developmental index at 36 months. [Conclusion] The results indicate the need for
early prediction of developmental delay and timely intervention, by assessing social
skills in low birthweight infants.
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Affiliation(s)
- Yuko Sawada
- Department of Physical Therapy, Morinomiya University of Medical Sciences: 1-26-16 Nanko-kita, Suminoe-ku, Osaka 559-8611, Japan
| | - Noritsugu Honda
- Department of Physical Therapy, Morinomiya University of Medical Sciences: 1-26-16 Nanko-kita, Suminoe-ku, Osaka 559-8611, Japan
| | - Makiko Narumiya
- Department of Pediatrics, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Japan
| | - Hiroshi Mizumoto
- Rehabilitation Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Japan
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24
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Sindelar R, Shepherd EG, Ågren J, Panitch HB, Abman SH, Nelin LD. Established severe BPD: is there a way out? Change of ventilatory paradigms. Pediatr Res 2021; 90:1139-1146. [PMID: 34012026 DOI: 10.1038/s41390-021-01558-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 02/04/2023]
Abstract
Improved survival of extremely preterm newborn infants has increased the number of infants at risk for developing bronchopulmonary dysplasia (BPD). Despite efforts to prevent BPD, many of these infants still develop severe BPD (sBPD) and require long-term invasive mechanical ventilation. The focus of research and clinical management has been on the prevention of BPD, which has had only modest success. On the other hand, research on the management of the established sBPD patient has received minimal attention even though this condition poses large economic and health problems with extensive morbidities and late mortality. Patients with sBPD, however, have been shown to respond to treatments focused not only on ventilatory strategies but also on multidisciplinary approaches where neurodevelopmental support, growth promoting strategies, and aggressive treatment of pulmonary hypertension improve their long-term outcomes. In this review we will try to present a physiology-based ventilatory strategy for established sBPD, emphasizing a possible paradigm shift from acute efforts to wean infants at all costs to a more chronic approach of stabilizing the infant. This chronic approach, herein referred to as chronic phase ventilation, aims at allowing active patient engagement, reducing air trapping, and improving ventilation-perfusion matching, while providing sufficient support to optimize late outcomes. IMPACT: Based on pathophysiological aspects of evolving and established severe BPD in premature infants, this review presents some lung mechanical properties of the most severe phenotype and proposes a chronic phase ventilatory strategy that aims at reducing air trapping, improving ventilation-perfusion matching and optimizing late outcomes.
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Affiliation(s)
- Richard Sindelar
- University Children's Hospital, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Edward G Shepherd
- Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Johan Ågren
- University Children's Hospital, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Howard B Panitch
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven H Abman
- Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Leif D Nelin
- University Children's Hospital, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
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25
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Siffel C, Kistler KD, Sarda SP. Global incidence of intraventricular hemorrhage among extremely preterm infants: a systematic literature review. J Perinat Med 2021; 49:1017-1026. [PMID: 33735943 DOI: 10.1515/jpm-2020-0331] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 02/16/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To conduct a systematic literature review to evaluate the global incidence of intraventricular hemorrhage grade 2-4 among extremely preterm infants. METHODS We performed searches in MEDLINE and Embase for intraventricular hemorrhage and prematurity cited in English language observational studies published from May 2006 to October 2017. Included studies analyzed data from infants born at ≤28 weeks' gestational age and reported on intraventricular hemorrhage epidemiology. RESULTS Ninety-eight eligible studies encompassed 39 articles from Europe, 31 from North America, 25 from Asia, five from Oceania, and none from Africa or South America; both Europe and North America were included in two publications. The reported global incidence range of intraventricular hemorrhage grade 3-4 was 5-52% (Europe: 5-52%; North America: 8-22%; Asia: 5-36%; Oceania: 8-13%). When only population-based studies were included, the incidence range of intraventricular hemorrhage grade 3-4 was 6-22%. The incidence range of intraventricular hemorrhage grade 2 was infrequently documented and ranged from 5-19% (including population-based studies). The incidence of intraventricular hemorrhage was generally inversely related to gestational age. CONCLUSIONS Intraventricular hemorrhage is a frequent complication of extremely preterm birth. Intraventricular hemorrhage incidence range varies by region, and the global incidence of intraventricular hemorrhage grade 2 is not well documented.
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Affiliation(s)
- Csaba Siffel
- Global Evidence and Outcomes, Takeda, Lexington, MA, USA.,College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| | - Kristin D Kistler
- Evidence Synthesis, Modeling & Communication, Evidera, Waltham, MA, USA
| | - Sujata P Sarda
- Global Evidence and Outcomes, Takeda, Lexington, MA, USA
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26
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Cuevas Guaman M, Dahm PH, Welty SE. The challenge of accurately describing the epidemiology of bronchopulmonary dysplasia (BPD) based on the various current definitions of BPD. Pediatr Pulmonol 2021; 56:3527-3532. [PMID: 33913625 DOI: 10.1002/ppul.25434] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 03/12/2021] [Accepted: 04/08/2021] [Indexed: 02/05/2023]
Abstract
Despite marked improvements in the survival of extremely low birth weight preterm infants, bronchopulmonary dysplasia (BPD) remains a prevalent morbidity. BPD has evolved pathologically and epidemiologically but the definition has failed to keep up. The majority of the definitions of BPD still use the respiratory support provided to the infants at a single timepoint. The lack of a uniform definition of BPD presently reflects the changing BPD pathogenesis and phenotype and limits defining the epidemiology. To address the epidemiology of BPD, the definition should be clarified; even the newer definitions have not been validated entirely. The definition needs to be meaningful clinically and be predictive of long-term respiratory outcomes. We believe the definition should have a composite assessment like a score (quantitative measurement) and include the different phenotypes (qualitative measurements) so that optimally they can be applied to the different phases of BPD and at different timepoints. Furthermore, the definitions need to be easy to measure and assess so that generalizability is enhanced.
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Affiliation(s)
- Milenka Cuevas Guaman
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Paul H Dahm
- Department of Pediatrics, Division of Critical Care Medicine, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Stephen E Welty
- Department of Pediatrics, Section of Neonatology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington, USA
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27
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Kihara H, Nakano H, Nakamura T, Gima H. Infant's Behaviour Checklist for low birth weight infants and later neurodevelopmental outcome. Sci Rep 2021; 11:19286. [PMID: 34588563 PMCID: PMC8481230 DOI: 10.1038/s41598-021-98884-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/15/2021] [Indexed: 11/09/2022] Open
Abstract
Assessment of the characteristics of spontaneous movements and behaviour in early infancy helps in estimating developmental outcomes. We introduced the Infant Behaviour Checklist (IBC) and examined the relationship between the behavioural characteristics of low-birth-weight infants and neurodevelopmental outcomes at 6 years of age. The behavioural characteristics during the neonatal (36-43 weeks, adjusted) and early infancy periods (49-60 weeks, adjusted) were assessed in very-low-birth-weight infants. The IBC includes 44 common behaviours. We assessed the appearance of individual behavioural characteristics at each period according to the neurodevelopmental outcome. Of the 143 infants assessed during the neonatal period, 89 had typical development (TD), 30 had intellectual disability (ID), and 24 had autism spectrum disorder (ASD). In 78 infants assessed during early infancy, 40, 21, and 17 had TD, ID, and ASD, respectively. The frequency of appearance of three behaviour-related items was significantly lower in the ID group than in the TD group. The frequency of appearance of three posture- and behaviour-related items was significantly lower, while that of two posture-related items was significantly higher, in the ASD group than in the TD group. Behavioural assessment using the IBC may provide promising clues when considering early intervention for low-birth-weight infants.
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Affiliation(s)
- Hideki Kihara
- Babycastle Corporation, 373-1, Tsubuku-imamachi, Kurume City, Fukuoka, 830-8630, Japan
| | - Hisako Nakano
- Department of Physical Therapy, Kyorin University, 5-4-1 Shimorenjaku, Mitaka City, , Tokyo, 181-8612, Japan
| | - Tomohiko Nakamura
- Department of Neonatology, Nagano Children's Hospital, 3100, Toyoshina, Azumino City, Nagano, 399-8288, Japan
| | - Hirotaka Gima
- Department of Physical Therapy, Faculty of Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashi-Ogu, Arakawa-ku, Tokyo, 116-8551, Japan.
- Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashi-Ogu, Arakawa-ku, Tokyo, 116-8551, Japan.
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Yoneda N, Isayama T, Saito S, Shah PS, Santaguida P, Nakamura T, McDonald SD. Learning From Strengths: Improving Care by Comparing Perinatal Approaches Between Japan and Canada and Identifying Future Research Priorities. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:1388-1394.e1. [PMID: 34020070 DOI: 10.1016/j.jogc.2021.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Preterm birth (PTB) is the leading cause of infant morbidity and mortality worldwide. Canada and Japan each have strengths that can inform clinical decision-making, research, and health care policy regarding the prevention of PTB and its sequelae. Our objectives were to: 1) compare PTB rates, risk factors, management, and outcomes between Japan and Canada; 2) establish research priorities while fostering future collaborative opportunities; and 3) undertake knowledge translation of these findings. METHODS We conducted a literature review to identify publications that examined PTB rates, risk factors, prevention and management techniques, and outcomes in Japan and Canada. We conducted site visits at 4 Japanese tertiary centres and held a collaborative stakeholder meeting of parents, neonatologists, maternal-fetal medicine specialists, and researchers. RESULTS Japan reports lower rates of PTB, neonatal mortality, and several PTB risk factors than Canada. However, Canadian PTB data is population-based, whereas, in Japan, the rate of PTB is population-based, but outcomes are not. Rates of severe neurologic injury and necrotizing enterocolitis were lower in Japan, while Canada's rates of bronchopulmonary dysplasia and retinopathy of prematurity were lower. PTB prevention approaches differed, with less progesterone use in Japan and more long-term tocolysis. In Japan, there were lower rates of neonatal transfers and non-faculty overnight care, but also less use of antenatal corticosteroids and deferred cord clamping. Research priorities identified through the stakeholder meeting included early skin-to-skin contact, parental well-being after PTB, and transitions in care for the child. CONCLUSION We identified key differences between Japan and Canada in the factors affecting PTB management and patient outcomes, which can inform future research efforts.
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Affiliation(s)
- Noriko Yoneda
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Tetsuya Isayama
- Division of Neonatology, Center of Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Shigeru Saito
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Prakesh S Shah
- Division of Neonatology, Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON
| | - Pasqualina Santaguida
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON; Department of Rehabilitation Sciences, McMaster University, Hamilton, ON
| | - Tomohiko Nakamura
- Division of Neonatology, Department of Pediatrics, Nagano Children's Hospital, Nagano, Japan
| | - Sarah D McDonald
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, McMaster University Hamilton, ON.
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Lee SH, Choi CW. The protective effect of CXC chemokine receptor 2 antagonist on experimental bronchopulmonary dysplasia induced by postnatal systemic inflammation. Clin Exp Pediatr 2021; 64:37-43. [PMID: 32683807 PMCID: PMC7806409 DOI: 10.3345/cep.2020.00381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/26/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Animal studies have shown that a leukocyte influx precedes the development of bronchopulmonary dysplasia (BPD) in premature sheep. The CXC chemokine receptor 2 (CXCR2) pathway has been implicated in the pathogenesis of BPD because of the predominance of CXCR2 ligands in tracheal aspirates of preterm infants who later developed BPD. PURPOSE To test the effect of CXCR2 antagonist on postnatal systemic and pulmonary inflammation and alveolarization in a newborn Sprague-Dawley rat model of BPD. METHODS Lipopolysaccharide (LPS) was injected intraperitoneally (i.p.) into the newborn rats on postnatal day 1 (P1), P3, and P5 to induce systemic inflammation and inhibit alveolarization. In the same time with LPS administration, CXCR2 antagonist (SB-265610) or vehicle was injected i.p. to investigate whether CXCR2 antagonist can alleviate the detrimental effect of LPS on alveolarization by attenuating inflammation. On P7 and P14, bronchoalveolar lavage fluid (BALF) and peripheral blood (PB) were collected from the pups. To assess alveolarization, mean cord length and alveolar surface area were measured on 4 random nonoverlapping fields per animal in 2 distal lung sections at ×100 magnification. RESULTS Early postnatal LPS administration significantly increased neutrophil counts in BALF and PB and inhibited alveolarization, which was indicated by a greater mean cord length and lesser alveolar surface area. CXCR2 antagonist significantly attenuated the increase of neutrophil counts in BALF and PB and restored alveolarization as indicated by a decreased mean cord length and increased alveolar surface area in rat pups exposed to early postnatal systemic LPS. CONCLUSION CXCR2 antagonist preserved alveolarization by alleviating pulmonary and systemic inflammation induced by early postnatal systemic LPS administration. These results suggest that CXCR2 antagonist can be considered a potential therapeutic agent for BPD that results from disrupted alveolarization induced by inflammation.
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Affiliation(s)
- Seung Hyun Lee
- Department of Pediatrics, Wonkwang University College of Medicine, Iksan, Korea
| | - Chang Won Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Al Hazzani F, Al-Alaiyan S, Kattan A, Binmanee A, Jabr MB, Al Midani E, Khadawardi E, Riaz F, Elsaidawi W. Short-term outcome of very low-birth-weight infants in a tertiary care hospital in Saudi Arabia over a decade. J Neonatal Perinatal Med 2020; 14:427-432. [PMID: 33337393 DOI: 10.3233/npm-200534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Knowledge on short-term outcomes of preterm infants is important for quality control. Our objective was to analyze the outcomes of very low birth weight infants admitted to our neonatal intensive care unit over a ten years' period and to compare the results with internationally published data. METHODS We analyzed the outcome measures for all live born infants with birth weight (BW) of 400-1500 grams and gestational age (GA) of 23-32 weeks born at King Faisal Specialist Hospital & Research Centre between 2006 and 2015. Results were compared to data from four international neonatal networks. RESULTS During the study period, we admitted 528 infants born at a gestational age of≥23 and≤32 weeks with a very low birth weight (VLBW) of 400-1500 grams. Mean (SD) GA was 28 (2.4) weeks and mean (SD) BW was 1007 (290) grams. A hundred and twenty-nine (24.4%) infants were small for gestational age and major congenital anomalies were present in 56 (10.6 %) infants. The rate of bronchopulmonary dysplasia (BPD) was 24.4 %, necrotizing enterocolitis (NEC) 9.1%, patent ductus arteriosus (PDA) 29.9%, severe intraventricular hemorrhage (IVH)10.8 %, periventricular leukomalacia (PVL) 5.7%, severe retinopathy of prematurity (ROP) 8%, and late-onset sepsis was 18.8%. The incidences of major neonatal outcomes such as CLD, NEC, severe IVH and severe ROP were comparable to the international cohorts. CONCLUSION In our population of preterm infants, survival rates and complications of prematurity were comparable to international data.
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Affiliation(s)
- F Al Hazzani
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - S Al-Alaiyan
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - A Kattan
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - A Binmanee
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - M B Jabr
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - E Al Midani
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - E Khadawardi
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - F Riaz
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - W Elsaidawi
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Abstract
Bronchopulmonary dysplasia (BPD) is among the most severe complications of very premature birth. Clinical and laboratory studies indicate that lung immaturity, inflammatory lung injury, and disordered lung repair are the primary mechanisms responsible for the development of BPD. Caffeine, initiated within the first 10 days after birth, is one of few drug therapies shown to significantly decrease the risk of BPD in very low birth weight infants. This benefit is likely derived, at least in part, from reduced exposure to positive airway pressure and supplemental oxygen with caffeine therapy. Additional cardiorespiratory benefits of caffeine that may contribute to the lower risk of BPD include less frequent treatment for a PDA, improved pulmonary mechanics, and direct effects on pulmonary inflammation, alveolarization, and angiogenesis. Routine administration of caffeine is indicated in the vast majority of very low birth weight infants. However, current preventative strategies including widespread use of caffeine do not avert BPD in all cases. As such, there is continued need for novel methods to further reduce the risk of BPD in very low birth weight infants.
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Affiliation(s)
- Erik A Jensen
- Division of Neonatology and Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, United States.
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32
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Lee JH, Youn Y, Chang YS. Short- and long-term outcomes of very low birth weight infants in Korea: Korean Neonatal Network update in 2019. Clin Exp Pediatr 2020; 63:284-290. [PMID: 32023404 PMCID: PMC7402988 DOI: 10.3345/cep.2019.00822] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 12/11/2019] [Indexed: 01/26/2023] Open
Abstract
Korea currently has the world's lowest birth rate but a rapidly inreasing number of preterm infants. The Korean Neonatal Network (KNN), launched by the Korean Society of Neonatology under the support of Korea Centers for Disease Control, has collected population-based data for very low birth weight infants (VLBWIs) born in Korea since 2013. In terms of the short-term outcomes of VLBWIs born from 2013 to 2016 registered in the KNN, the survival rate of all VLBWIs was 86%. Respiratory distress syndrome and bronchopulmonary dysplasia were observed in 78% and 30% of all VLBWIs, respectively. Necrotizing enterocolitis occurred in 7%, while 8% of the VLBWIs needed therapy for retinopathy of prematurity in the neonatal intensive care unit (NICU). Sepsis occurred in 21% during their NICU stay. Intraventricular hemorrhage (grade ≥III) was diagnosed in 10%. In terms of the long-term outcomes for VLBWIs born from 2013 to 2014 registered in the KNN, the post-discharge mortality rate was approximately 1.2%-1.5%, mainly owing to their underlying illness. Nearly half of the VLBWIs were readmitted to the hospital at least once in their first 1-2 years of life, mostly as a result of respiratory diseases. The overall prevalence of cerebral palsy was 6.2%-6.6% in Korea. Bilateral blindness was reported in 0.2%-0.3% of VLBWIs, while bilateral hearing loss was found in 0.8%-1.9%. Since its establishment, the KNN has published annual reports and papers that facilitate the improvement of VLBWI outcome and the formulation of essential healthcare policies in Korea.
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Affiliation(s)
- Jang Hoon Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - YoungAh Youn
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Carter BS. From Iowa: Cautious Optimism? J Pediatr 2020; 217:9-10. [PMID: 31590944 DOI: 10.1016/j.jpeds.2019.09.050] [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: 09/10/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Brian S Carter
- Marjorie & William T. Sirridge Professor of Medical Humanities & Bioethics, Professor of Pediatrics (Neonatology), University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri.
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Lin H, Wang X. The effects of gasotransmitters on bronchopulmonary dysplasia. Eur J Pharmacol 2020; 873:172983. [PMID: 32017936 DOI: 10.1016/j.ejphar.2020.172983] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/22/2020] [Accepted: 01/31/2020] [Indexed: 02/06/2023]
Abstract
Bronchopulmonary dysplasia (BPD), which remains a major clinical problem for preterm infants, is caused mainly by hyperoxia, mechanical ventilation and inflammation. Many approaches have been developed with the aim of decreasing the incidence of or alleviating BPD, but effective methods are still lacking. Gasotransmitters, a type of small gas molecule that can be generated endogenously, exert a protective effect against BPD-associated lung injury; nitric oxide (NO), carbon monoxide (CO) and hydrogen sulfide (H2S) are three such gasotransmitters. The protective effects of NO have been extensively studied in animal models of BPD, but the results of these studies are inconsistent with those of clinical trials. NO inhalation seems to have no effect on BPD, although side effects have been reported. NO inhalation is not recommended for BPD treatment in preterm infants, except those with severe pulmonary hypertension. Both CO and H2S decreased lung injury in BPD rodent models in preclinical studies. Another small gas molecule, hydrogen, exerts a protective effect against BPD. The nuclear factor erythroid-derived 2 (Nrf2)/heme oxygenase-1 (HO-1) axis seems to play a central role in the protective effect of these gasotransmitters on BPD. Gasotransmitters play important roles in mammals, but further clinical trials are needed to explore their effects on BPD.
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Affiliation(s)
- Hai Lin
- Department of Traditional Chinese Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Xinbao Wang
- Department of Pediatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China.
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Zozaya C, García González I, Avila-Alvarez A, Oikonomopoulou N, Sánchez Tamayo T, Salguero E, Saenz de Pipaón M, García-Muñoz Rodrigo F, Couce ML. Incidence, Treatment, and Outcome Trends of Necrotizing Enterocolitis in Preterm Infants: A Multicenter Cohort Study. Front Pediatr 2020; 8:188. [PMID: 32478014 PMCID: PMC7237564 DOI: 10.3389/fped.2020.00188] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/30/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Data regarding the incidence and mortality of necrotizing enterocolitis trends are scarce in the literature. Recently, some preventive strategies have been confirmed (probiotics) or increased (breastfeeding rate). This study aims to describe the trends of necrotizing enterocolitis incidence, treatment, and mortality over the last decade in Spain. Methods: Multicenter cohort study with data from the Spanish Neonatal Network-SEN1500 database. The study period comprised from January 2005 to December 2017. Preterm infants <32 weeks of gestational age at birth without major congenital malformations were included for analysis. The main study outcomes were necrotizing enterocolitis incidence, co-morbidity (bronchopulmonary dysplasia, late-onset sepsis, cystic periventricular leukomalacia, retinopathy of prematurity, acute kidney injury), mortality, and surgical/non-surgical treatment. Results: Among the 25,821 included infants, NEC incidence was 8.8% during the whole study period and remained stable when comparing 4-year subperiods. However, more cases were surgically treated (from 48.8% in 2005-2008 to 70.2% in 2015-2017, p < 0.001). Mortality improved from 36.7% in the 2005-2008 to 26.6% in 2015-2017 (p < 0.001). Breastfeeding rates improved over the studied years (24.3% to 40.5%, p < 0.001), while gestational age remained invariable (28.5 weeks, p = 0.20). Prophylactic probiotics were implemented during the study period in some units, reaching 18.6% of the patients in 2015-2017. Conclusions: The incidence of necrotizing enterocolitis remained stable despite the improvement regarding protective factors frequency. Surgical treatment became more frequent over the study period, whereas mortality decreased.
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Affiliation(s)
- Carlos Zozaya
- Division of Neonatology, Hospital for Sick Children, Toronto, ON, Canada
| | - Inés García González
- Neonatology Department, Complexo Hospitalario Universitario de Santiago de Compostela, Health Research Institute of Santiago de Compostela, A Coruña, Spain
| | - Alejandro Avila-Alvarez
- Neonatal Unit, Department of Paediatrics, Complexo Hospitalario Universitario A Coruña, Institute for Biomedical Research A Coruña, A Coruña, Spain
| | | | - Tomás Sánchez Tamayo
- Neonatology Department, Malaga Regional Hospital, Malaga Biomedical Research Institute-IBIMA, Malaga, Spain
| | - Enrique Salguero
- Neonatology Department, Malaga Regional Hospital, Malaga Biomedical Research Institute-IBIMA, Malaga, Spain
| | - Miguel Saenz de Pipaón
- Neonatology Department, Hospital Universitario La Paz, Hospital La Paz Institute for Health Research, Madrid, Spain.,Red Samid, Maternal and Child Health and Development Research Network, Carlos III Health Institute, Madrid, Spain
| | - Fermín García-Muñoz Rodrigo
- Division of Neonatology, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - María L Couce
- Neonatology Department, Complexo Hospitalario Universitario de Santiago de Compostela, Health Research Institute of Santiago de Compostela, A Coruña, Spain.,Red Samid, Maternal and Child Health and Development Research Network, Carlos III Health Institute, Madrid, Spain
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Care Practices, Morbidity and Mortality of Preterm Neonates in China, 2013-2014: a Retrospective study. Sci Rep 2019; 9:19863. [PMID: 31882629 PMCID: PMC6934849 DOI: 10.1038/s41598-019-56101-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 12/02/2019] [Indexed: 11/09/2022] Open
Abstract
This retrospective cohort study aimed to investigate the prevalence, morbidity, mortality and the maternal/neonatal care of preterm neonates and the perinatal risk factors for mortality. We included data on 13,701 preterm neonates born in 15 hospitals for the period 2013–2014 in China. Results showed a prevalence of preterm neonates of 9.9%. Most infants at 24–27 weeks who survived more than 12 hours were mechanically ventilated (56.1%). Few infants born before 28 weeks received CPAP without first receiving mechanical ventilation (8.1%). Few preterm neonates received antenatal steroid(35.8% at 24–27 weeks, 57.9% at 28–31 weeks, 57.0% at 32–33 weeks and 32.7% at 34–36 weeks). Overall mortality was 1.9%. Most of the deaths at 24–27 weeks of gestation occurred within 12 hours after birth, accounting for 68.1%(32/47), and within 12–72 hours after birth at 28–36 weeks of gestation, accounting for 47.4%(99/209). Rates of survival to discharge increased from 68.2% at 24–27 weeks, 93.3% at 28–31 weeks, 99.2% at 32–33 weeks to 99.4% at 34–36 weeks. The smaller of the GA, there was a greater risk of morbidities due to prematurity. Preterm birth weight (OR = 0.407, 95% CI 0.346–0.478), antenatal steroid (OR = 0.680, 95% CI 0.493–0.938), and neonatal asphyxia (OR = 3.215, 95% CI 2.180–4.741) proved to significantly influence the odds of preterm neonatal death. Overall, our results support that most of the preterm neonates at 28–36 weeks of gestation survived without major morbidity. Rate of survival of GAs less than 28 weeks was still low. Maternal and infant care practices need to be improved in the very preterm births.
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Singh H, Kaur R, Saluja S, Cho SJ, Kaur A, Pandey AK, Gupta S, Das R, Kumar P, Palma J, Yadav G, Sun Y. Development of data dictionary for neonatal intensive care unit: advancement towards a better critical care unit. JAMIA Open 2019; 3:21-30. [PMID: 32607484 PMCID: PMC7309238 DOI: 10.1093/jamiaopen/ooz064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/18/2019] [Accepted: 11/17/2019] [Indexed: 11/14/2022] Open
Abstract
Background Critical care units (CCUs) with extensive use of various monitoring devices generate massive data. To utilize the valuable information of these devices; data are collected and stored using systems like clinical information system and laboratory information management system. These systems are proprietary, allow limited access to their database and, have the vendor-specific clinical implementation. In this study, we focus on developing an open-source web-based meta-data repository for CCU representing stay of the patient with relevant details. Methods After developing the web-based open-source repository named data dictionary (DD), we analyzed prospective data from 2 sites for 4 months for data quality dimensions (completeness, timeliness, validity, accuracy, and consistency), morbidity, and clinical outcomes. We used a regression model to highlight the significance of practice variations linked with various quality indicators. Results DD with 1555 fields (89.6% categorical and 11.4% text fields) is presented to cover the clinical workflow of a CCU. The overall quality of 1795 patient days data with respect to standard quality dimensions is 87%. The data exhibit 88% completeness, 97% accuracy, 91% timeliness, and 94% validity in terms of representing CCU processes. The data scores only 67% in terms of consistency. Furthermore, quality indicators and practice variations are strongly correlated (P < 0.05). Conclusion This study documents DD for standardized data collection in CCU. DD provides robust data and insights for audit purposes and pathways for CCU to target practice improvements leading to specific quality improvements.
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Affiliation(s)
- Harpreet Singh
- Child Health Imprints (CHIL) Pte. Ltd, Singapore, Singapore
| | - Ravneet Kaur
- Child Health Imprints (CHIL) Pte. Ltd, Singapore, Singapore
| | - Satish Saluja
- Department of Neonatology, Sir Ganga Ram Hospital, New Delhi, India
| | - Su Jin Cho
- Department of pediatrics, College of Medicine, Ewha Woman's University Seoul, Seoul, Republic of Korea
| | - Avneet Kaur
- Department of Pediatrics, Apollo Hospitals, New Delhi, India
| | - Ashish Kumar Pandey
- Department of Mathematics, Indraprastha Institute of Information Technology, New Delhi, India
| | - Shubham Gupta
- Child Health Imprints (CHIL) Pte. Ltd, Singapore, Singapore
| | - Ritu Das
- Child Health Imprints (CHIL) Pte. Ltd, Singapore, Singapore
| | - Praveen Kumar
- Department of Neonatology, PGIMER, Chandigarh, India
| | - Jonathan Palma
- Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Gautam Yadav
- Department of Pediatrics, Kalawati Hospital, Rewari, India
| | - Yao Sun
- Department of pediatrics, UCSF Benioff Children's Hospital, William H. Tooley Intensive Care Nursery, San Francisco, California, USA
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Wu F, Liu G, Feng Z, Tan X, Yang C, Ye X, Dai Y, Liang W, Ye X, Mo J, Ding L, Wu B, Chen H, Li C, Zhang Z, Rong X, Shen W, Huang W, Yang B, Lv J, Huo L, Huang H, Rao H, Yan W, Yang Y, Ren X, Wang F, Liu D, Diao S, Liu X, Meng Q, Wang Y, Wang B, Zhang L, Huang Y, Ao D, Li W, Chen J, Chen Y, Li W, Chen Z, Ding Y, Li X, Huang Y, Lin N, Cai Y, Han S, Jin Y, Wan Z, Ban Y, Bai B, Li G, Yan Y, Cui Q. Short-term outcomes of extremely preterm infants at discharge: a multicenter study from Guangdong province during 2008-2017. BMC Pediatr 2019; 19:405. [PMID: 31685004 PMCID: PMC6827215 DOI: 10.1186/s12887-019-1736-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 09/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND An increasing number of extremely preterm (EP) infants have survived worldwide. However, few data have been reported from China. This study was designed to investigate the short-term outcomes of EP infants at discharge in Guangdong province. METHODS A total of 2051 EP infants discharged from 26 neonatal intensive care units during 2008-2017 were enrolled. The data from 2008 to 2012 were collected retrospectively, and from 2013 to 2017 were collected prospectively. Their hospitalization records were reviewed. RESULTS During 2008-2017, the mean gestational age (GA) was 26.68 ± 1.00 weeks and the mean birth weight (BW) was 935 ± 179 g. The overall survival rate at discharge was 52.5%. There were 321 infants (15.7%) died despite active treatment, and 654 infants (31.9%) died after medical care withdrawal. The survival rates increased with advancing GA and BW (p < 0.001). The annual survival rate improved from 36.2% in 2008 to 59.3% in 2017 (p < 0.001). EP infants discharged from hospitals in Guangzhou and Shenzhen cities had a higher survival rate than in others (p < 0.001). The survival rate of EP infants discharged from general hospitals was lower than in specialist hospitals (p < 0.001). The major complications were neonatal respiratory distress syndrome, 88.0% (1804 of 2051), bronchopulmonary dysplasia, 32.3% (374 of 1158), retinopathy of prematurity (any grade), 45.1% (504 of 1117), necrotizing enterocolitis (any stage), 10.1% (160 of 1588), intraventricular hemorrhages (any grade), 37.4% (535 of 1431), and blood culture-positive nosocomial sepsis, 15.7% (250 of 1588). The multivariate logistic regression analysis indicated that improved survival of EP infants was associated with discharged from specialist hospitals, hospitals located in high-level economic development region, increasing gestational age, increasing birth weight, antenatal steroids use and a history of premature rupture of membranes. However, twins or multiple births, Apgar ≤7 at 5 min, cervical incompetence, and decision to withdraw care were associated with decreased survival. CONCLUSIONS Our study revealed the short-term outcomes of EP infants at discharge in China. The overall survival rate was lower than the developed countries, and medical care withdrawal was a serious problem. Nonetheless, improvements in care and outcomes have been made annually.
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Affiliation(s)
- Fan Wu
- Department of Neonatology, the First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
- Department of Pediatrics, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China
| | - Guosheng Liu
- Department of Neonatology, the First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China.
| | - Zhoushan Feng
- Department of Pediatrics, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China
| | - Xiaohua Tan
- Department of Pediatrics, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China
| | - Chuanzhong Yang
- Department of Neonatology, Shenzhen Maternal & Child Healthcare Hospital, Affiliated Southern Medical University, Shenzhen, 518028, Guangdong, China
| | - Xiaotong Ye
- Department of Neonatology, Shenzhen Maternal & Child Healthcare Hospital, Affiliated Southern Medical University, Shenzhen, 518028, Guangdong, China
| | - Yiheng Dai
- Department of Neonatology, Foshan Maternal and Child's Hospital, Foshan, 528000, Guangdong, China
| | - Weiyi Liang
- Department of Neonatology, Foshan Maternal and Child's Hospital, Foshan, 528000, Guangdong, China
| | - Xiuzhen Ye
- Department of Neonatology, Women and Children Hospital of Guangdong Province, Guangzhou, 510010, Guangdong, China
| | - Jing Mo
- Department of Neonatology, Women and Children Hospital of Guangdong Province, Guangzhou, 510010, Guangdong, China
| | - Lu Ding
- Department of Neonatology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China
| | - Benqing Wu
- Department of Neonatology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China
| | - Hongxiang Chen
- Department of Neonatology, Meizhou People's Hospital, Meizhou, 514031, Guangdong, China
| | - Chiwang Li
- Department of Neonatology, Meizhou People's Hospital, Meizhou, 514031, Guangdong, China
| | - Zhe Zhang
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou, 510120, Guangdong, China
| | - Xiao Rong
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou, 510120, Guangdong, China
| | - Wei Shen
- Department of Neonatology, Nanfang Hospital of Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Weimin Huang
- Department of Neonatology, Nanfang Hospital of Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Bingyan Yang
- Department of Neonatology, Boai Hospital of Zhongshan, Zhongshan, 528400, Guangdong, China
| | - Junfeng Lv
- Department of Neonatology, Boai Hospital of Zhongshan, Zhongshan, 528400, Guangdong, China
| | - Leying Huo
- Department of Neonatology, Zhuhai Maternity and Child Health Hospital, Zhuhai, 519001, Guangdong, China
| | - Huiwen Huang
- Department of Neonatology, Zhuhai Maternity and Child Health Hospital, Zhuhai, 519001, Guangdong, China
| | - Hongping Rao
- Department of Neonatology, Huizhou Municipal Central Hospital, Huizhou, 516001, Guangdong, China
| | - Wenkang Yan
- Department of Neonatology, Huizhou Municipal Central Hospital, Huizhou, 516001, Guangdong, China
| | - Yong Yang
- Department of Neonatology, Dongguan Maternity and Child Health Hospital, Dongguan, 523002, Guangdong, China
| | - Xuejun Ren
- Department of Neonatology, Dongguan Maternity and Child Health Hospital, Dongguan, 523002, Guangdong, China
| | - Fangfang Wang
- Department of Neonatology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-sen University, Jiangmen, 529000, Guangdong, China
| | - Dong Liu
- Department of Neonatology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-sen University, Jiangmen, 529000, Guangdong, China
| | - Shiguang Diao
- Department of Neonatology, Yuebei People's Hospital, Shaoguan, 512026, Guangdong, China
| | - Xiaoyan Liu
- Department of Neonatology, Yuebei People's Hospital, Shaoguan, 512026, Guangdong, China
| | - Qiong Meng
- Department of Neonatology, Guangdong Second Provincial People's Hospital, Guangzhou, 510317, Guangdong, China
| | - Yu Wang
- Department of Neonatology, Guangdong Second Provincial People's Hospital, Guangzhou, 510317, Guangdong, China
| | - Bin Wang
- Department of Pediatrics, Zhujiang Hospital of Southern Medical University, Guangzhou, 510280, Guangdong, China
| | - Lijuan Zhang
- Department of Pediatrics, Zhujiang Hospital of Southern Medical University, Guangzhou, 510280, Guangdong, China
| | - Yuge Huang
- Department of Pediatrics, the Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, Guangdong, China
| | - Dang Ao
- Department of Pediatrics, the Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, Guangdong, China
| | - Weizhong Li
- Department of Neonatology, the Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Jieling Chen
- Department of Neonatology, the Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Yanling Chen
- Department of Neonatology, Jinan University Medical College Affiliated Dongguan Hospital, Dongguan, 523900, Guangdong, China
| | - Wei Li
- Department of Neonatology, Jinan University Medical College Affiliated Dongguan Hospital, Dongguan, 523900, Guangdong, China
| | - Zhifeng Chen
- Department of Pediatrics, Dongguan People's Hospital, Dongguan, 523000, Guangdong, China
| | - Yueqin Ding
- Department of Pediatrics, Dongguan People's Hospital, Dongguan, 523000, Guangdong, China
| | - Xiaoyu Li
- Department of Neonatology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Yuefang Huang
- Department of Neonatology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Niyang Lin
- Department of Neonatology, the First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Yangfan Cai
- Department of Neonatology, the First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Shasha Han
- Department of Neonatology, the First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Ya Jin
- Department of Neonatology, the First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Zhonghe Wan
- Department of Neonatology, Nanhai District People's Hospital of Foshan, Foshan, 528200, Guangdong, China
| | - Yi Ban
- Department of Neonatology, Nanhai District People's Hospital of Foshan, Foshan, 528200, Guangdong, China
| | - Bo Bai
- Department of Neonatology, Huadu District People's Hospital of Guangzhou, Guangzhou, 510800, Guangdong, China
| | - Guanghong Li
- Department of Neonatology, Huadu District People's Hospital of Guangzhou, Guangzhou, 510800, Guangdong, China
| | - Yuexiu Yan
- Department of Pediatrics, the First People's Hospital of Zhaoqing, Zhaoqing, 526020, Guangdong, China
| | - Qiliang Cui
- Department of Pediatrics, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China.
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Godeluck A, Gérardin P, Lenclume V, Mussard C, Robillard PY, Sampériz S, Benhammou V, Truffert P, Ancel PY, Ramful D. Mortality and severe morbidity of very preterm infants: comparison of two French cohort studies. BMC Pediatr 2019; 19:360. [PMID: 31623604 PMCID: PMC6796444 DOI: 10.1186/s12887-019-1700-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/29/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND In Reunion Island, a French overseas department, the burden of preterm birth and perinatal mortality exceed those observed in mainland France, despite similar access to standard perinatal care. The purpose of the study was to compare the outcome of two cohorts of NICU-admitted very preterm infants born between 24 and 31 weeks of gestation (WG): the registry-based OGP (Observatoire de la Grande Prématurité, Reunion Island, 2008-2013) cohort, and the nationwide EPIPAGE-2 (mainland France, 2011) observational cohort. METHODS The primary outcome was adverse neonatal outcomes defined as a composite indicator of in-hospital mortality or any of three following severe morbidities: bronchopulmonary dysplasia (BPD), necrotising enterocolitis, or severe neurological injury (periventricular leukomalacia or grade III-IV intraventricular haemorrhages). Logistic regression modelling adjusting for confounders was performed. RESULTS A total of 1272 very preterm infants from the Reunionese OGP cohort and 3669 peers from the mainland EPIPAGE-2 cohort were compared. Adverse neonatal outcomes were more likely observed in the OGP cohort (32.6% versus 26.6%, p < 0.001), as result of both increased in-hospital mortality across all gestational age strata and increased BPD among the survivors of the 29-31 WG stratum. After adjusting for gestational age, gender and multiple perinatal factors, the risk of adverse neonatal outcomes was higher in the OGP cohort than in the EPIPAGE-2 cohort across all gestational age strata. CONCLUSIONS Despite similar guidelines for standard perinatal care, very preterm infants born in Reunion Island have a higher risk for death or severe morbidity compared with those born in mainland France.
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Affiliation(s)
| | - Patrick Gérardin
- INSERM CIC1410 Epidémiologie Clinique, CHU de la Réunion, Saint Pierre, Réunion
| | - Victorine Lenclume
- INSERM CIC1410 Epidémiologie Clinique, CHU de la Réunion, Saint Pierre, Réunion
| | - Corinne Mussard
- INSERM CIC1410 Epidémiologie Clinique, CHU de la Réunion, Saint Pierre, Réunion
| | - Pierre-Yves Robillard
- CHU de la Réunion, Saint Pierre, Réunion
- Centre d'Etudes Périnatales de l'Océan Indien (CEPOI), Université de la Réunion, EA 7388, Saint-Denis, France
| | | | | | - Patrick Truffert
- CHU Lille, EA 2694 Public Health, Epidemiology and Quality of Care unit, F-59000, Lille, France
| | - Pierre-Yves Ancel
- INSERM U 1153, CHU Cochin Hôtel Dieu, Paris, France
- Université Paris Descartes, Paris, France
- URC - CIC1419 Plurithématique, Cochin Hôtel Dieu, Paris, France
| | - Duksha Ramful
- CHU de la Réunion, Saint Denis, Réunion.
- INSERM CIC1410 Epidémiologie Clinique, CHU de la Réunion, Saint Pierre, Réunion.
- Postal address: Neonatal and pediatric intensive care unit, Félix Guyon Hospital, CHU de La Réunion, Allée des Topazes, CS 11021, 97400, Saint-Denis Cedex, La Réunion, France.
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Valenzuela-Stutman D, Marshall G, Tapia JL, Mariani G, Bancalari A, Gonzalez Á. Bronchopulmonary dysplasia: risk prediction models for very-low- birth-weight infants. J Perinatol 2019; 39:1275-1281. [PMID: 31337853 DOI: 10.1038/s41372-019-0430-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/03/2019] [Accepted: 05/23/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Our objective is to develop risk prediction models for moderate/severe bronchopulmonary dysplasia (BPD) and BPD and/or death in very-low-birth-weight infants (VLBWI) at birth, 3, 7, and 14 postnatal days. STUDY DESIGN It is a multicenter study including 16,407 infants weighing 500-1500 g (2001-2015) from the Neocosur Network. BPD was defined as oxygen dependency at 36 weeks. Variables were selected using forward logistic regression models. Predictive values were evaluated using the ROC curve. RESULTS In total, 2580 (15.7%) presented BPD and 6121 (37.3%) BPD/death. The AUC values for the BPD models were 0.788, 0.818, 0.827, and 0.894 respectively. For BPD/death, the AUC values were 0.860, 0.869, 0.867, and 0.906. BW and gestational age had higher contribution at birth; at later ages, the length of oxygen therapy and ventilation had the highest contribution. All AUC values were statistically significant when compared with a neutral value of 0.5 (p-value < 0.001). CONCLUSIONS We developed high predictive power models for moderate/severe BPD and BPD/death at four postnatal ages.
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Affiliation(s)
- Daniela Valenzuela-Stutman
- Departamento de Neonatología, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
| | - Guillermo Marshall
- Departamento de Neonatología, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - José L Tapia
- Departamento de Neonatología, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Gonzalo Mariani
- Unidad de Neonatologia, Instituto Universitario Hospital Italiano Buenos Aires, Potosí, Argentina
| | - Aldo Bancalari
- Servicio de Neonatología, Hospital Guillermo Grant Benavente y Departamento de Pediatría, Facultad de Medicina, Universidad de Concepción, Concepcion, Chile
| | - Álvaro Gonzalez
- Departamento de Neonatología, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Siffel C, Kistler KD, Lewis JFM, Sarda SP. Global incidence of bronchopulmonary dysplasia among extremely preterm infants: a systematic literature review. J Matern Fetal Neonatal Med 2019; 34:1721-1731. [PMID: 31397199 DOI: 10.1080/14767058.2019.1646240] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Infants born extremely preterm (<28 weeks gestational age (GA)) face a high risk of neonatal mortality. Bronchopulmonary dysplasia (BPD) is the most common morbidity of prematurity. OBJECTIVE To evaluate the global incidence of BPD among infants born extremely preterm. DESIGN A systematic review of the literature was conducted in Embase and MEDLINE (via PubMed) using a prespecified search strategy for BPD and prematurity. Observational studies published in English between 16 May 2006 and 16 October 2017 reporting on the occurrence of BPD in infants born <28 weeks GA were included. RESULTS Literature searches yielded 103 eligible studies encompassing 37 publications from Europe, 38 publications from North America, two publications from Europe and North America, 19 publications from Asia, one publication from Asia and North America, six publications from Oceania, and zero publications from Africa or South America. The reported global incidence range of BPD was 10-89% (10-73% in Europe, 18-89% in North America, 18-82% in Asia, and 30-62% in Oceania). When only population-based observational studies that defined BPD as requiring supplemental oxygen at 36 weeks postmenstrual age were included, the global incidence range of BPD was 17-75%. The wide range of incidences reflected interstudy differences in GA (which was inversely related to BPD incidence), birthweight, and survival rates across populations and institutions. CONCLUSIONS BPD is a common health morbidity occurring with extremely preterm birth. Further study of factors that impact incidence, aside from low GA, may help to elucidate modifiable risks.
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Affiliation(s)
- Csaba Siffel
- Takeda, Lexington, MA, USA.,College of Allied Health Sciences, Augusta University, Augusta, GA, USA
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Bronchopulmonary dysplasia frequency and risk factors in very low birth weight infants: A 3-year retrospective study. North Clin Istanb 2019; 7:124-130. [PMID: 32259033 PMCID: PMC7117633 DOI: 10.14744/nci.2019.23427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 07/17/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: In this study, the relationship between the frequency of bronchopulmonary dysplasia, perinatal risk factors and other prematurity comorbidities were evaluated in very low birth weight infants. METHODS: A total of 872 very low birth weight infants’ files were retrospectively reviewed. The effects of the clinical parameters, such as type of birth, small for gestational age, gender, antenatal steroids, early membrane rupture, chorioamnionitis, surfactant administration, respiratory distress syndrome, patent ductus arteriosus, apnea, early and late sepsis on the frequency of bronchopulmonary dysplasia, were evaluated by binary logistic regression analysis. RESULTS: The overall mortality rate was 20.9%. After the first 28-day mortality reduction, the total bronchopulmonary dysplasia frequency was found to be 20.1%. The odds ratio and 95% confidence intervals of the factors affecting the development of bronchopulmonary dysplasia were found to be as follows respectively: respiratory distress syndrome (OR 6.2, 95% CI 3.6–10.6, p<0.01), patent ductus arteriosus (OR 4.9, 95% Cl 2.4–9.9, p<0.01), apnea (OR 4.1, 95% CI 2.5–6.9, p<0.01), late sepsis (OR 2.7, 95% CI 1.6–4.5, p<0.01), early membrane rupture (OR 2.6, 95% Cl 1.2–5.5, p=0.01), and male gender (OR 1.6, 95% CI 1.0-2.7, p=0.04) was found. However, there was no effect of chorioamnionitis, antenatal steroids, small for gestational age, early sepsis and type of birth on bronchopulmonary dysplasia. CONCLUSION: Differently from the usual factors which are low birth weight and a gestational week, there was a significant but non-linear risk relationship between respiratory distress syndrome, patent ductus arteriosus, late sepsis, apnea, early membrane rupture, male gender and bronchopulmonary dysplasia.
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Konishi KI, Yoshida M, Nakao A, Tsuchiya K, Tsurisawa C, Ichiki K, Takeda T, Hisaeda Y, Hirota A, Amagata S, Odashima T, Yokomori K, Ishida K, Matsuura M, Ito S, Fujiwara M, Nakahara S. Prostaglandin E-major urinary metabolite as a noninvasive surrogate marker for infantile necrotizing enterocolitis. J Pediatr Surg 2019; 54:1584-1589. [PMID: 30291024 DOI: 10.1016/j.jpedsurg.2018.08.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/10/2018] [Accepted: 08/14/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Early definitive diagnosis of necrotizing enterocolitis (NEC) based on Bell's staging criteria is difficult because there are few observable changes on abdominal imaging and blood chemistry tests at the onset of the disease. PURPOSE To investigate whether prostaglandin E-2 major urinary metabolite (PGE-MUM) can be a useful surrogate marker reflecting the disease state and severity of NEC in infants. METHODS Infants were enrolled in this study between January 2014 and December 2016. NEC diagnosis was based on Bell's staging criteria > Stage II or necrotic bowel observed at surgery. After diagnosis, PGE-MUM level was measured and compared with that of the other disease and healthy infant groups. RESULTS Median PGE-MUM value was highest in the NEC group (576 [65-3672] μg/g•Cre/BSA × 1000), followed by the other disease group (94 [57-296] μg/g•Cre/BSA × 1000) and the healthy infant group (19 [10-44] μg/g•Cre/BSA × 1000) (sensitivity: 92.3%, specificity: 81.5%, accuracy: 85.0%; p < 0.01). PGE-MUM level correlated with improved status of NEC, length of necrotic intestine, and Bell's staging criteria. CONCLUSIONS PGE-MUM level may be a useful surrogate biomarker reflecting the disease state of NEC. The method of urine sample collection is also advantageous, being noninvasive for infants. This is the first study reporting PGE-MUM level in NEC. TYPE OF STUDY Study of diagnostic test. LEVEL OF EVIDENCE LEVEL II.
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Affiliation(s)
- Ken-Ichiro Konishi
- Department of Pediatric Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Mariko Yoshida
- Department of Pediatric Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Atsushi Nakao
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Keiji Tsuchiya
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Chisa Tsurisawa
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kunihiko Ichiki
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Tomohiro Takeda
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yoshiya Hisaeda
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Atsushi Hirota
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Shusuke Amagata
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Takayuki Odashima
- Department of Pediatrics, Tajimi Shimin Hospital, Tajimi, Gifu, Japan
| | - Kinji Yokomori
- Department of Pediatric Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kazuo Ishida
- Department of Pediatric Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Masaaki Matsuura
- Graduate School of Public Health, Teikyo University, Tokyo, Japan
| | - Satoru Ito
- IDAC Theranostics, Inc., Bunkyo, Tokyo, Japan
| | - Mutsunori Fujiwara
- Department of Clinical Pathology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Saori Nakahara
- Department of Pediatric Surgery, Japanese Red Cross Medical Center, Tokyo, Japan.
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Isayama T. The clinical management and outcomes of extremely preterm infants in Japan: past, present, and future. Transl Pediatr 2019; 8:199-211. [PMID: 31413954 PMCID: PMC6675688 DOI: 10.21037/tp.2019.07.10] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
There is a wide variation in neonatal mortality rates across regions and countries. Japan has one of the lowest neonatal mortality rates in the world; in particular, the mortality rate of extremely preterm infants (i.e., those born before 26 weeks of gestation) is much lower in Japan than in other developed countries. In addition, Japan has low incidences of intraventricular hemorrhage, necrotizing enterocolitis, and late-onset sepsis, a very high incidence of retinopathy of prematurity, and a relatively high incidence of chronic lung disease. In Japan, general perinatal medical centers (PMCs), which are PMCs that offer the highest levels of care, are required to have an obstetric department with maternal-fetal intensive care units as well as a neonatal or pediatric department with neonatal intensive care units (NICU), in order to promote antenatal rather than neonatal maternal transfer of high-risk cases. The limit of viability of extremely preterm infants is 22 weeks of gestation, and approximately half of them are estimated to receive active resuscitation. The clinical management of extremely preterm infants in Japan are characterized by (I) circulatory management that is guided by neonatologist-performed echocardiography, (II) relatively invasive respiratory management, (III) nutritional management, which entails the promotion of breast milk feeding, early enteral feeding, routine glycerin enema, and the administration of probiotics, (IV) neurological management by means of minimal handling, sedation of ventilated infants, and serial brain ultrasounds, and (V) infection control with the assistance of serial C-reactive protein (CRP) monitoring. Thus, this review provides a brief description of the development of neonatology in Japan, introduces the unique features of Japanese clinical management of extremely preterm infants, and overviews their outcomes.
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Affiliation(s)
- Tetsuya Isayama
- Division of Neonatology, Center of Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
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45
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Adams M, Bassler D. Practice variations and rates of late onset sepsis and necrotizing enterocolitis in very preterm born infants, a review. Transl Pediatr 2019; 8:212-226. [PMID: 31413955 PMCID: PMC6675686 DOI: 10.21037/tp.2019.07.02] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/08/2019] [Indexed: 01/01/2023] Open
Abstract
The burden of late onset sepsis (LOS) and necrotizing enterocolitis (NEC) remains high for newborns in low- and high-income countries. Very preterm born infants born below 32 weeks gestation are at highest risk because their immune system is not yet adapted to ex-utero life, providing intensive care frequently compromises their skin or mucosa and they require a long duration of hospital stay. An epidemiological overview is difficult to provide because there is no mutually accepted definition available for either LOS or NEC. LOS incidence proportions are generally reported based on identified blood culture pathogens. However, discordance in minimum day of onset and whether coagulase negative staphylococci or fungi should be included into the reported proportions lead to variation in reported incidences. Complicating the comparison are the absence of biomarkers, ancillary lab tests or prediction models with sufficiently high positive and/or negative predictive values. The only high negative predictive values result from negative blood culture results with negative lab results allowing to discontinue antibiotic treatment. Similar difficulties exist in reporting and diagnosing NEC. Although most publications base their proportions on a modified version of Bell's stage 2 or 3, comparisons are made difficult by the multifactorial nature of the disease reflecting several pathways to intestinal necrosis, the absence of a reliable biomarker and the unclear differentiation from spontaneous intestinal perforations. Comparable reports in very low birthweight infants range between 5% and 30% for LOS and 1.6% to 7.1% for NEC. Evidence based guidelines to support treatment are missing. Treatment for LOS remains largely empirical and focused mainly on antibiotics. In the absence of a clear diagnosis, even unspecific early warning signals need to be met with antibiotic treatment. Cessation after negative blood culture is difficult unless the child was asymptomatic from the beginning. As a result, antibiotics are the most commonly prescribed medications, but unnecessary exposure may result in increased risk for mortality, NEC, further infections and childhood obesity or asthma. Finding ways to limit antibiotic use are thus important and have shown a large potential for improvement of care and limitation of cost. Over recent decades, none of the attempts to establish novel therapies have succeeded. LOS and NEC proportions remained mostly stable. During the past 10 years however, publications emerged reporting a reduction, sometimes by almost 50%. Most concern units participating in a surveillance system using quality improvement strategies to prevent LOS or NEC (e.g., hand hygiene, evidence based "bundles", feeding onset, providing own mother's milk). We conclude that these approaches display a potential for wider spread reduction of LOS and NEC and for a subsequently more successful development of novel therapies as these often address the same pathways as the prevention strategies.
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Affiliation(s)
- Mark Adams
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Shah PS, Lui K, Reichman B, Norman M, Kusuda S, Lehtonen L, Adams M, Vento M, Darlow BA, Modi N, Rusconi F, Håkansson S, San Feliciano L, Helenius KK, Bassler D, Hirano S, Lee SK. The International Network for Evaluating Outcomes (iNeo) of neonates: evolution, progress and opportunities. Transl Pediatr 2019; 8:170-181. [PMID: 31413951 PMCID: PMC6675683 DOI: 10.21037/tp.2019.07.06] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 07/05/2019] [Indexed: 01/15/2023] Open
Abstract
Neonates born very preterm (before 32 weeks' gestational age), are a significant public health concern because of their high-risk of mortality and life-long disability. In addition, caring for very preterm neonates can be expensive, both during their initial hospitalization and their long-term cost of permanent impairments. To address these issues, national and regional neonatal networks around the world collect and analyse data from their constituents to identify trends in outcomes, and conduct benchmarking, audit and research. Improving neonatal outcomes and reducing health care costs is a global problem that can be addressed using collaborative approaches to assess practice variation between countries, conduct research and implement evidence-based practices. The International Network for Evaluating Outcomes (iNeo) of neonates was established in 2013 with the goal of improving outcomes for very preterm neonates through international collaboration and comparisons. To date, 10 national or regional population-based neonatal networks/datasets participate in iNeo collaboration. The initiative now includes data on >200,000 very preterm neonates and has conducted important epidemiological studies evaluating outcomes, variations and trends. The collaboration has also surveyed >320 neonatal units worldwide to learn about variations in practices, healthcare service delivery, and physical, environmental and manpower related factors and support services for parents. The iNeo collaboration serves as a strong international platform for Neonatal-Perinatal health services research that facilitates international data sharing, capacity building, and global efforts to improve very preterm neonate care.
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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
| | - Kei Lui
- Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, University of New South Wales, Randwick, Australia
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Ramat Gan, Israel
| | - Mikael Norman
- Department of Neonatal Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Satoshi Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Mark Adams
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Maximo Vento
- Division of Neonatology and Health Research Institute La Fe, Valencia, Spain
| | - Brian A Darlow
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Neena Modi
- UK Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital campus, London, UK
| | - Franca Rusconi
- Neonatal Intensive Care Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Stellan Håkansson
- Department of Clinical Sciences/Pediatrics, Umeå University Hospital, Umeå, Sweden
| | | | - Kjell K Helenius
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Shinya Hirano
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - 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
- Department of Obstetrics and Gynecology and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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47
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Jin YT, Duan Y, Deng XK, Lin J. Prevention of necrotizing enterocolitis in premature infants – an updated review. World J Clin Pediatr 2019; 8:23-32. [PMID: 31065543 PMCID: PMC6477149 DOI: 10.5409/wjcp.v8.i2.23] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/31/2018] [Accepted: 01/28/2019] [Indexed: 02/06/2023] Open
Abstract
Necrotizing enterocolitis (NEC) is among the most common and devastating diseases encountered in premature infants, yet the true etiology continues to be poorly understood despite decades of research. Recently, gut bacterial dysbiosis has been proposed as a risk factor for the development of NEC. Based on this theory, several best clinical practices designed to reduce the risk of NEC have been proposed and/or implemented. This review summarizes the results of recent clinical trials and meta-analyses that support some of the existing clinical practices for reducing the risk of NEC in premature infants. It is evident that human milk feeding can reduce the incidence of NEC. While most of the studies demonstrated that probiotic supplementation can significantly reduce the incidence of NEC in premature infants, there are still some concerns regarding the quality, safety, optimal dosage, and treatment duration of probiotic preparations. Antibiotic prophylaxis does not reduce the incidence of NEC, and prolonged initial empirical use of antibiotics might in fact increase the risk of NEC for high-risk premature infants. Lastly, standardized feeding protocols are strongly recommended, both for prevention of postnatal growth restriction and NEC.
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Affiliation(s)
- Yu-Ting Jin
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Yue Duan
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Xiao-Kai Deng
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Jing Lin
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
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Glaser K, Gradzka-Luczewska A, Szymankiewicz-Breborowicz M, Kawczynska-Leda N, Henrich B, Waaga-Gasser AM, Speer CP. Perinatal Ureaplasma Exposure Is Associated With Increased Risk of Late Onset Sepsis and Imbalanced Inflammation in Preterm Infants and May Add to Lung Injury. Front Cell Infect Microbiol 2019; 9:68. [PMID: 31001484 PMCID: PMC6454044 DOI: 10.3389/fcimb.2019.00068] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/04/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Controversy remains concerning the impact of Ureaplasma on preterm neonatal morbidity. Methods: Prospective single-center study in very low birth weight infants <30 weeks' gestation. Cord blood and initial nasopharyngeal swabs were screened for Ureaplasma parvum and U. urealyticum using culture technique and polymerase chain reaction. Neonatal outcomes were followed until death or discharge. Multi-analyte immunoassay provided cord blood levels of inflammatory markers. Using multivariate regression analyses, perinatal Ureaplasma exposure was evaluated as risk factor for the development of bronchopulmonary dysplasia (BPD), other neonatal morbidities until discharge and systemic inflammation at admission. Results: 40/103 (39%) infants were positive for Ureaplasma in one or both specimens, with U. parvum being the predominant species. While exposure to Ureaplasma alone was not associated with BPD, we found an increased risk of BPD in Ureaplasma-positive infants ventilated ≥5 days (OR 1.64; 95% CI 0.12–22.98; p = 0.009). Presence of Ureaplasma was associated with a 7-fold risk of late onset sepsis (LOS) (95% CI 1.80–27.39; p = 0.014). Moreover, Ureaplasma-positive infants had higher I/T ratios (b 0.39; 95% CI 0.08–0.71; p = 0.014), increased levels of interleukin (IL)-17 (b 0.16; 95% CI 0.02–0.30; p = 0.025) and matrix metalloproteinase 8 (b 0.77; 95% CI 0.10–1.44; p = 0.020), decreased levels of IL-10 (b −0.77; 95% CI −1.58 to −0.01; p = 0.043) and increased ratios of Tumor necrosis factor-α, IL-8, and IL-17 to anti-inflammatory IL-10 (p = 0.003, p = 0.012, p < 0.001). Conclusions: Positive Ureaplasma screening was not associated with BPD. However, exposure contributed to BPD in infants ventilated ≥5 days and conferred an increased risk of LOS and imbalanced inflammatory cytokine responses.
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Affiliation(s)
- Kirsten Glaser
- University Children's Hospital, University of Wuerzburg, Wuerzburg, Germany
| | | | | | | | - Birgit Henrich
- Institute of Medical Microbiology and Hospital Hygiene, University Clinic of Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | - Ana Maria Waaga-Gasser
- Department of Surgery I, Molecular Oncology and Immunology, University of Wuerzburg, Wuerzburg, Germany
| | - Christian P Speer
- University Children's Hospital, University of Wuerzburg, Wuerzburg, Germany
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Abstract
Progressing necrotizing enterocolitis research is difficult because the disease is variable in presentation, there are difficulties in making a precise diagnosis, a reliable agreed case-definition is currently lacking, and there is a paucity of preclinical research to identify etiologic targets. The major challenges of the cost of clinical trials and need for long-term outcome ascertainment could be eased through incorporation of novel randomization approaches and data collection into routine care, and collaboration between public-sector and industry funders.
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50
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Huang J, Zhang L, Tang J, Shi J, Qu Y, Xiong T, Mu D. Human milk as a protective factor for bronchopulmonary dysplasia: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2019; 104:F128-F136. [PMID: 29907614 DOI: 10.1136/archdischild-2017-314205] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 05/09/2018] [Accepted: 05/11/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To summarise current evidence evaluating the effects of human milk on the risk of bronchopulmonary dysplasia (BPD) in preterm infants. DESIGN We searched for studies on human milk and BPD in English and Chinese databases on 26 July 2017. Furthermore, the references of included studies were also screened. The inclusion criteria in this meta-analysis were the following: (1) preterm infants (<37 weeks); (2) human milk; (3) comparing with formula feeding; (4) the outcome included BPD; and (5) the type of study was randomised controlled trial (RCT) or cohort study. RESULT A total of 17 cohort studies and 5 RCTs involving 8661 preterm infants met our inclusion criteria. The ORs and 95% CIs of six groups were as follows: 0.78 (0.68 to 0.88) for exclusive human milk versus exclusive formula group, 0.77 (0.68 to 0.87) for exclusive human milk versus mainly formula group, 0.76 (0.68 to 0.87) for exclusive human milk versus any formula group, 0.78 (0.68 to 0.88) for mainly human milk versus exclusive formula group, 0.83 (0.69 to 0.99) for mainly human milk versus mainly formula group and 0.82 (0.73 to 0.93) for any human milk versus exclusive formula group. Notably, subgroup of RCT alone showed a trend towards protective effect of human milk on BPD but no statistical significance. CONCLUSION Both exclusive human milk feeding and partial human milk feeding appear to be associated with lower risk of BPD in preterm infants. The quality of evidence is low. Therefore, more RCTs of this topic are needed.
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Affiliation(s)
- Jinglan Huang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Li Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Jun Tang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Jing Shi
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Yi Qu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Tao Xiong
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
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