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D'Adamo E, Levantini G, Librandi M, Botondi V, Di Ricco L, De Sanctis S, Spagnuolo C, Gazzolo F, Gavilanes DA, Di Gregorio P, Di Monte J, Strozzi MC, Maconi A, Cassinari M, Libener R, Gazzolo D. Fetal chronic hypoxia does not affect urinary presepsin levels in newborns at birth. Clin Chem Lab Med 2024; 62:1643-1648. [PMID: 38353160 DOI: 10.1515/cclm-2023-1308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/24/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVES Early sepsis detection and diagnosis still constitutes an open issue since the accuracy of standard-of care parameters is biased by a series of perinatal factors including hypoxia. Therefore, we aimed at investigating the effect of fetal chronic hypoxia insult on urine levels of a promising new marker of sepsis, namely presepsin (P-SEP). METHODS We conducted a prospective case-control study in 22 cases of early-intrauterine growth restriction (E-IUGR) compared with 22 small-for-gestational-age (SGA) newborns and 66 healthy controls. P-SEP urine samples were collected over the first 72 h from birth. Blood culture and C-reactive protein (CRP) blood levels were measured in E-IUGR and SGA infants. Perinatal standard monitoring parameters and main outcomes were also recorded. RESULTS No significant urinary P-SEP differences (p>0.05, for all) were observed among studied groups. Moreover, no significant correlations (p>0.05, for both) between urinary P-SEP and blood CRP levels in both E-IUGR and SGA groups (R=0.08; R=0.07, respectively) were observed. CONCLUSIONS The present results showing the lack of influence of fetal chronic hypoxia on urinary P-SEP levels offer additional data to hypothesize the possible use of urinary P-SEP measurement in neonates in daily clinical practice. Further multicenter prospective data are needed, including infants with early-onset sepsis.
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Affiliation(s)
- Ebe D'Adamo
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
| | | | - Michela Librandi
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
| | - Valentina Botondi
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
| | - Laura Di Ricco
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
| | - Sara De Sanctis
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
| | - Cynzia Spagnuolo
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
| | | | - Danilo Aw Gavilanes
- Department of Pediatrics and Neonatology, Maastricht University, Maastricht, The Netherlands
| | | | | | - Maria Chiara Strozzi
- Department of Pediatrics and Neonatology, Ospedale Cardinal Massaia, Asti, Italy
| | - Antonio Maconi
- Social Security Administration Development and Promotion of Scientific Research Unit, SS Antonio, Biagio and C. Arrigo Hospital, Alessandria, Italy
| | - Maurizio Cassinari
- Department of Clinical Biochemistry, Transfusion and Regeneration Medicine Alessandria Hospital, Alessandria, Italy
| | - Roberta Libener
- Department of Clinical Biochemistry, Transfusion and Regeneration Medicine Alessandria Hospital, Alessandria, Italy
| | - Diego Gazzolo
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
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Amornjiraporn I, Rugsapol S, Thanasarnpaiboon P, Paes B, Kitsommart R. A comparison of the effect of procedural pain on cerebral oxygen saturation between late preterm and term infants. J Perinatol 2024:10.1038/s41372-024-01978-4. [PMID: 38789794 DOI: 10.1038/s41372-024-01978-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVES We prospectively compared cerebral oxygen saturation (CrSO2) and pain score changes during procedures in late preterm (LPT) versus term infants. METHODS Near-infrared spectroscopy, pulse oximetry, Neonatal Infant Pain Scale (NIPS) and Premature Infant Pain Profile-Revised (PIPP-R) scores were assessed and CrSO2 data analyzed. RESULTS Thirty infants in each group were evaluated. LPT infants displayed a milder significant drop in Minimum post-procedural CrSO2 and smaller Maximum-Minimum post-procedural CrSO2 disparity. CrSO2 minute changes between the groups were non-significant. Moderate correlations were observed in both groups between NIPS and Minimum post-procedural CrSO2, and a moderate correlation was found in the Maximum-Minimum post-procedural CrSO2 difference in LPT infants. No correlation between PIPP-R and CrSO2 values was noted. CONCLUSION LPT and term infants demonstrated decreased CrSO2 in response to painful procedures. Correlations between CrSO2 and PIPP-R or NIPS scores were poor to moderate, reflecting the complex nature of these associations relative to gestational age.
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Affiliation(s)
- Ittichote Amornjiraporn
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supranee Rugsapol
- Nursing Division, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Peerawit Thanasarnpaiboon
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Bosco Paes
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Ratchada Kitsommart
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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3
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Darrow LA, Huang M, Warren JL, Strickland MJ, Holmes HA, Newman AJ, Chang HH. Preterm and Early-Term Delivery After Heat Waves in 50 US Metropolitan Areas. JAMA Netw Open 2024; 7:e2412055. [PMID: 38787560 PMCID: PMC11127119 DOI: 10.1001/jamanetworkopen.2024.12055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/16/2024] [Indexed: 05/25/2024] Open
Abstract
Importance Heat waves are increasing in frequency, intensity, and duration and may be acutely associated with pregnancy outcomes. Objective To examine changes in daily rates of preterm and early-term birth after heat waves in a 25-year nationwide study. Design, Setting, and Participants This cohort study of singleton births used birth records from 1993 to 2017 from the 50 most populous US metropolitan statistical areas (MSAs). The study included 53 million births, covering 52.8% of US births over the period. Data were analyzed between October 2022 and March 2023 at the National Center for Health Statistics. Exposures Daily temperature data from Daymet at 1-km2 resolution were averaged over each MSA using population weighting. Heat waves were defined in the 4 days (lag, 0-3 days) or 7 days (lag, 0-6 days) preceding birth. Main Outcomes and Measures Daily counts of preterm birth (28 to <37 weeks), early-term birth (37 to <39 weeks), and ongoing pregnancies in each gestational week on each day were enumerated in each MSA. Rate ratios for heat wave metrics were obtained from time-series models restricted to the warm season (May to September) adjusting for MSA, year, day of season, and day of week, and offset by pregnancies at risk. Results There were 53 154 816 eligible births in the 50 MSAs from 1993 to 2017; 2 153 609 preterm births and 5 795 313 early-term births occurring in the warm season were analyzed. A total of 30.0% of mothers were younger than 25 years, 53.8% were 25 to 34 years, and 16.3% were 35 years or older. Heat waves were positively associated with daily rates of preterm and early-term births, showing a dose-response association with heat wave duration and temperatures and stronger associations in the more acute 4-day window. After 4 consecutive days of mean temperatures exceeding the local 97.5th percentile, the rate ratio for preterm birth was 1.02 (95% CI, 1.00-1.03), and the rate ratio for early-term birth was 1.01 (95% CI, 1.01-1.02). For the same exposure, among those who were 29 years of age or younger, had a high school education or less, and belonged to a racial or ethnic minority group, the rate ratios were 1.04 (95% CI, 1.02-1.06) for preterm birth and 1.03 (95% CI, 1.02-1.05) for early-term birth. Results were robust to alternative heat wave definitions, excluding medically induced deliveries, and alternative statistical model specifications. Conclusions and Relevance In this cohort study, preterm and early-term birth rates increased after heat waves, particularly among socioeconomically disadvantaged subgroups. Extreme heat events have implications for perinatal health.
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Affiliation(s)
- Lyndsey A. Darrow
- Department of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Nevada, Reno
| | - Mengjiao Huang
- Department of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Nevada, Reno
- Geriatric Research and Education Clinical Center, Veterans Affairs Health Care Systems, Palo Alto, California
| | - Joshua L. Warren
- Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut
| | - Matthew J. Strickland
- Department of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Nevada, Reno
| | - Heather A. Holmes
- Department of Chemical Engineering, John and Marcia Price College of Engineering, University of Utah, Salt Lake City
| | - Andrew J. Newman
- Research Applications Laboratory, National Center for Atmospheric Research, Boulder, Colorado
| | - Howard H. Chang
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia
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4
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Alexander T, Asadi S, Meyer M, Harding JE, Jiang Y, Alsweiler JM, Muelbert M, Bloomfield FH. Nutritional Support for Moderate-to-Late-Preterm Infants - A Randomized Trial. N Engl J Med 2024; 390:1493-1504. [PMID: 38657245 DOI: 10.1056/nejmoa2313942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Most moderate-to-late-preterm infants need nutritional support until they are feeding exclusively on their mother's breast milk. Evidence to guide nutrition strategies for these infants is lacking. METHODS We conducted a multicenter, factorial, randomized trial involving infants born at 32 weeks 0 days' to 35 weeks 6 days' gestation who had intravenous access and whose mothers intended to breast-feed. Each infant was assigned to three interventions or their comparators: intravenous amino acid solution (parenteral nutrition) or dextrose solution until full feeding with milk was established; milk supplement given when maternal milk was insufficient or mother's breast milk exclusively with no supplementation; and taste and smell exposure before gastric-tube feeding or no taste and smell exposure. The primary outcome for the parenteral nutrition and the milk supplement interventions was the body-fat percentage at 4 months of corrected gestational age, and the primary outcome for the taste and smell intervention was the time to full enteral feeding (150 ml per kilogram of body weight per day or exclusive breast-feeding). RESULTS A total of 532 infants (291 boys [55%]) were included in the trial. The mean (±SD) body-fat percentage at 4 months was similar among the infants who received parenteral nutrition and those who received dextrose solution (26.0±5.4% vs. 26.2±5.2%; adjusted mean difference, -0.20; 95% confidence interval [CI], -1.32 to 0.92; P = 0.72) and among the infants who received milk supplement and those who received mother's breast milk exclusively (26.3±5.3% vs. 25.8±5.4%; adjusted mean difference, 0.65; 95% CI, -0.45 to 1.74; P = 0.25). The time to full enteral feeding was similar among the infants who were exposed to taste and smell and those who were not (5.8±1.5 vs. 5.7±1.9 days; P = 0.59). Secondary outcomes were similar across interventions. Serious adverse events occurred in one infant. CONCLUSIONS This trial of routine nutrition interventions to support moderate-to-late-preterm infants until full nutrition with mother's breast milk was possible did not show any effects on the time to full enteral feeding or on body composition at 4 months of corrected gestational age. (Funded by the Health Research Council of New Zealand and others; DIAMOND Australian New Zealand Clinical Trials Registry number, ACTRN12616001199404.).
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Affiliation(s)
- Tanith Alexander
- From Liggins Institute (T.A., S.A., J.E.H., M. Muelbert, F.H.B.), the Department of Statistics, Faculty of Science (Y.J.), and the Department of Paediatrics, Child and Youth Health (J.M.A.), University of Auckland, and the Neonatal Unit, Kidz First, Middlemore Hospital, Te Whatu Ora Counties Manukau (T.A., M. Meyer), Auckland, and Newborn Services, Starship Child Health, Te Toka Tumai Auckland, Te Whatu Ora (J.M.A.) - all in New Zealand
| | - Sharin Asadi
- From Liggins Institute (T.A., S.A., J.E.H., M. Muelbert, F.H.B.), the Department of Statistics, Faculty of Science (Y.J.), and the Department of Paediatrics, Child and Youth Health (J.M.A.), University of Auckland, and the Neonatal Unit, Kidz First, Middlemore Hospital, Te Whatu Ora Counties Manukau (T.A., M. Meyer), Auckland, and Newborn Services, Starship Child Health, Te Toka Tumai Auckland, Te Whatu Ora (J.M.A.) - all in New Zealand
| | - Michael Meyer
- From Liggins Institute (T.A., S.A., J.E.H., M. Muelbert, F.H.B.), the Department of Statistics, Faculty of Science (Y.J.), and the Department of Paediatrics, Child and Youth Health (J.M.A.), University of Auckland, and the Neonatal Unit, Kidz First, Middlemore Hospital, Te Whatu Ora Counties Manukau (T.A., M. Meyer), Auckland, and Newborn Services, Starship Child Health, Te Toka Tumai Auckland, Te Whatu Ora (J.M.A.) - all in New Zealand
| | - Jane E Harding
- From Liggins Institute (T.A., S.A., J.E.H., M. Muelbert, F.H.B.), the Department of Statistics, Faculty of Science (Y.J.), and the Department of Paediatrics, Child and Youth Health (J.M.A.), University of Auckland, and the Neonatal Unit, Kidz First, Middlemore Hospital, Te Whatu Ora Counties Manukau (T.A., M. Meyer), Auckland, and Newborn Services, Starship Child Health, Te Toka Tumai Auckland, Te Whatu Ora (J.M.A.) - all in New Zealand
| | - Yannan Jiang
- From Liggins Institute (T.A., S.A., J.E.H., M. Muelbert, F.H.B.), the Department of Statistics, Faculty of Science (Y.J.), and the Department of Paediatrics, Child and Youth Health (J.M.A.), University of Auckland, and the Neonatal Unit, Kidz First, Middlemore Hospital, Te Whatu Ora Counties Manukau (T.A., M. Meyer), Auckland, and Newborn Services, Starship Child Health, Te Toka Tumai Auckland, Te Whatu Ora (J.M.A.) - all in New Zealand
| | - Jane M Alsweiler
- From Liggins Institute (T.A., S.A., J.E.H., M. Muelbert, F.H.B.), the Department of Statistics, Faculty of Science (Y.J.), and the Department of Paediatrics, Child and Youth Health (J.M.A.), University of Auckland, and the Neonatal Unit, Kidz First, Middlemore Hospital, Te Whatu Ora Counties Manukau (T.A., M. Meyer), Auckland, and Newborn Services, Starship Child Health, Te Toka Tumai Auckland, Te Whatu Ora (J.M.A.) - all in New Zealand
| | - Mariana Muelbert
- From Liggins Institute (T.A., S.A., J.E.H., M. Muelbert, F.H.B.), the Department of Statistics, Faculty of Science (Y.J.), and the Department of Paediatrics, Child and Youth Health (J.M.A.), University of Auckland, and the Neonatal Unit, Kidz First, Middlemore Hospital, Te Whatu Ora Counties Manukau (T.A., M. Meyer), Auckland, and Newborn Services, Starship Child Health, Te Toka Tumai Auckland, Te Whatu Ora (J.M.A.) - all in New Zealand
| | - Frank H Bloomfield
- From Liggins Institute (T.A., S.A., J.E.H., M. Muelbert, F.H.B.), the Department of Statistics, Faculty of Science (Y.J.), and the Department of Paediatrics, Child and Youth Health (J.M.A.), University of Auckland, and the Neonatal Unit, Kidz First, Middlemore Hospital, Te Whatu Ora Counties Manukau (T.A., M. Meyer), Auckland, and Newborn Services, Starship Child Health, Te Toka Tumai Auckland, Te Whatu Ora (J.M.A.) - all in New Zealand
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D'Adamo E, Botondi V, Falconio L, Giardinelli G, Di Gregorio P, Caputi S, Sinjari B, Trubiani O, Traini T, Gazzolo F, Strozzi MC, Maconi A, Gazzolo D. Effect of temperature on presepsin pre-analytical stability in biological fluids of preterm and term newborns. Clin Chem Lab Med 2024; 62:1011-1016. [PMID: 38018456 DOI: 10.1515/cclm-2023-1282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVES Thermostability is one of the pre-requisites for the reliability of analytes in clinical practice and biomedical research. Although presepsin represents a promising new biomarker for the early diagnosis of sepsis in newborns, data on its stability under different storage conditions are lacking. We aimed to investigate presepsin thermostability in blood, urine and saliva samples after thawing at 4 predetermined monitoring time-points in a cohort of preterm and term infants. METHODS We conducted an observational study, where each case served as its own control, in 24 preterm and term infants. Blood, urine and saliva samples were stored at -80 °C for 18 months, and presepsin measured in different biological fluids at thawing (T0), 24 (T1), 48 (T2) and at 72 (T3) hours after thawing. RESULTS No significant differences (p>0.05, for all) in presepsin levels were observed at T0-T3 in the different biological fluids. Furthermore, no differences at T0-T3 were observed in presepsin levels between blood and saliva fluids, whilst urine levels were significantly higher (p<0.05, for all) than blood and saliva at T0-T3. CONCLUSIONS Results on presepsin pre-analytical thermo-stability in different biological fluids after long-term refrigeration support the reliability of this biomarker in the diagnosis and monitoring of perinatal sepsis.
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Affiliation(s)
- Ebe D'Adamo
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
| | - Valentina Botondi
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
| | - Luigi Falconio
- Department of Innovative Technologies in Medicine and Dentistry, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | | | - Patrizia Di Gregorio
- Immunohematology and Transfusional Medicine Service, "SS. Annunziata" Hospital, Chieti, Italy
| | - Sergio Caputi
- Department of Innovative Technologies in Medicine and Dentistry, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Bruna Sinjari
- Department of Innovative Technologies in Medicine and Dentistry, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Oriana Trubiani
- Department of Innovative Technologies in Medicine and Dentistry, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Tonino Traini
- Department of Innovative Technologies in Medicine and Dentistry, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Francesca Gazzolo
- Pediatric Unit, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Maria Chiara Strozzi
- Department of Maternal Fetal and Neonatal Medicine, C. Arrigo Children's Hospital Alessandria, Alessandria, Italy
| | - Antonio Maconi
- Department of Maternal Fetal and Neonatal Medicine, C. Arrigo Children's Hospital Alessandria, Alessandria, Italy
| | - Diego Gazzolo
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
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6
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Özkan S, Dereli ML, Kurt D, Kurt A, Sucu S, Fıratlıgil FB, İşleyen F, Çelen Ş, Üstün YE. The use of late preterm antenatal corticosteroids in women with gestational diabetes : a puzzle worth solving. BMC Pregnancy Childbirth 2024; 24:286. [PMID: 38637735 PMCID: PMC11027230 DOI: 10.1186/s12884-024-06510-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 04/11/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND To investigate the association between late preterm antenatal corticosteroid treatment and outcome in late preterm neonates born to mothers with gestational diabetes mellitus, METHODS: All patients with gestational diabetes mellitus who had a late preterm delivery at Etlik Lady Zübeyde Hospital between 2017 and 2021 were included. Women who met the inclusion criteria and were not given antenatal corticosteroid treatment during current pregnancy before 34 0/7 weeks of gestation were divided into two groups according to whether or not they received late preterm antenatal corticosteroid treatment. The two groups were compared in terms of adverse neonatal complications. The main outcomes were composite respiratory outcome and composite neonatal outcome. Logistic regression analysis was used to determine additional potential predictors of neonatal outcome. RESULTS This retrospective cohort study included a total of 400 participants with gestational diabetes mellitus who had a late preterm delivery within the study period. Of these women, 196 (49%) received late preterm antenatal corticosteroid treatment. Main outcomes showed no difference. Decreasing gestational age at birth was identified as an independent risk factor predicting both composite respiratory outcome and composite neonatal outcome in multivariate logistic regression analysis. CONCLUSIONS Antenatal corticosteroid treatment at or after 34 0/7 weeks of gestation in women with gestational diabetes mellitus who had a late preterm delivery was not associated with improvement in adverse neonatal outcomes. Decreasing gestational age at birth was the only independent risk factor predicting composite neonatal and composite respiratory outcomes.
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Affiliation(s)
- Sadullah Özkan
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, P.O. box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey.
| | - Murat Levent Dereli
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, P.O. box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey
| | - Dilara Kurt
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, P.O. box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey
| | - Ahmet Kurt
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, P.O. box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey
| | - Sadun Sucu
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, P.O. box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey
| | - Fahri Burçin Fıratlıgil
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, P.O. box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey
| | - Fatih İşleyen
- Department of Neonatology, Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Şevki Çelen
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, P.O. box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey
| | - Yaprak Engin Üstün
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, P.O. box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey
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7
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Riddle S, Acharya K, Agarwal N, Ahmad I, Bendel-Stenzel E, Shepherd J, Williams S, Zaniletti I, Jacobson E. Gestational Age at Delivery and Neonatal Outcomes among Infants with Gastroschisis in the Children's Hospitals Neonatal Consortium (CHNC). Am J Perinatol 2024; 41:756-763. [PMID: 35553040 DOI: 10.1055/s-0042-1744510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The effect of gestational age (GA) on gastroschisis outcomes is unclear and delivery timing varies in practice. We aimed to correlate clinical outcomes of infants with gastroschisis and GA at delivery in the Children's Hospitals Neonatal Consortium (CHNC). STUDY DESIGN This was a retrospective multicenter cohort study of infants with gastroschisis admitted to CHNC neonatal intensive care units (NICUs) from 2010 to 2016. Patients were categorized by GA: 32 to 346/7, 35 to 366/7, and ≥37 weeks. Respiratory and feeding interventions, mortality, length of stay, and common complications were compared. RESULTS In 2021 for patients with gastroschisis, median GA at delivery was 36.3 weeks (interquartile range [IQR] 35.1, 37.3) and mean birth weight 2,425 g (IQR 2,100, 2,766). Overall mortality was low and there was no difference across GA groups. Infants <35 weeks' gestation had the greatest need for respiratory and feeding interventions. Complications such as medical necrotizing enterocolitis (NEC), cholestasis, and central line-associated blood stream infection were less common in infants ≥37 weeks. Feeding initiation and full feeds were earliest in term infants, compared with infants between 35 and 366/7 weeks, and longest in infants <35 weeks. Prematurity had a significant negative association with breast milk exposure. Enteral feeding tube support at discharge increased with prematurity. Compared with term, infants born between 35 and 366/7 weeks' gestation had a higher incidence of medical NEC and lower exposure to mother's milk at discharge but the need for respiratory interventions or tube feeding at discharge was similar. CONCLUSION Premature infants with gastroschisis had more neonatal complications including respiratory interventions, longer NICU stay, longer time to full enteral feeds, and higher need for tube feeds at discharge as compared with those delivered at term. Differences were greatest for those <35 weeks GA. While overall mortality remains low, these results provide additional information about GA at birth in gastroschisis, with no evidence of benefit from preterm delivery. KEY POINTS · Respiratory support was greatest for those with <35 weeks gestation.. · NEC and cholestasis increase with prematurity.. · Term infants have better feeding outcomes..
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Affiliation(s)
- Stefanie Riddle
- Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Krishna Acharya
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nidhi Agarwal
- Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Irfan Ahmad
- Department of Neonatology, Children's Hospital Orange County, Orange, California
| | | | - Jennifer Shepherd
- Division of Neonatology, Department of Pediatrics, Fetal and Neonatal Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | | | - Elizabeth Jacobson
- Seattle Children's Hospital and University of Washington School of Medicine, Seattle, Washington
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8
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Standish KR, Combs G, McMahon M, Slater C, Zani L, Pindar C, Serafin K, Parker MG, Philipp BL. Early Bloomers: A Nursing-Driven Program to Support Human Milk Feeding Among Late Preterm Infants in the Mother-Baby Unit. J Hum Lact 2024; 40:96-100. [PMID: 37994675 DOI: 10.1177/08903344231211513] [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] [Indexed: 11/24/2023]
Abstract
Late preterm infants have lower breastfeeding rates than term infants, yet few published interventions or guidelines exist to guide hospitals in managing them in the non-intensive nursery setting. Here we describe the development and implementation of an interdisciplinary, hospital-based, breastfeeding support program among late preterm infants not requiring intensive care. The Early Bloomer Program includes an order set applied at birth, immediate lactation consultation, availability of donor milk, parent education on late preterm infants, hand expression teaching and kit including spoon and video link, and daily interdisciplinary team huddles. The program was developed with staff input using Diffusion of Innovation Theory, and implemented first among early adopters before expanding to all postpartum nurses. Nursing staff received education on late preterm infant physiology and feeding, and trainings on the Early Bloomers program through various learning modalities during the year leading up to implementation. To further understand the strengths and weakness of the program, we surveyed nurses (n = 43). Nurses reported that they were more attentive to the needs of late preterm infants, more confident in their care, and more aware of possible complications and feeding needs. Areas noted in need of improvement included lack of overnight lactation consults and little involvement of labor and delivery staff in the program. The Early Bloomers program increased confidence in care and was well received by nurses. Well-designed clinical studies are needed to identify effective breastfeeding support practices for late preterm infants.
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Affiliation(s)
- Katherine R Standish
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA
| | | | | | | | - Lisa Zani
- Boston Medical Center, Boston, MA, USA
| | - Christina Pindar
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Karol Serafin
- Boston University School of Medicine, Boston, MA, USA
| | - Margaret G Parker
- Department of Pediatrics, UMass Chan Memorial Medical School, Boston, MA, USA
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
| | - Barbara L Philipp
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
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9
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Ekezie W, Hopwood E, Czyznikowska B, Weidman S, Mackintosh N, Curtis F. Perinatal health outcomes of women from Gypsy, Roma and Traveller communities: A systematic review. Midwifery 2024; 129:103910. [PMID: 38113569 DOI: 10.1016/j.midw.2023.103910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/10/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND GRT communities are disadvantaged minority groups in Europe and experience some of the poorest health outcomes, including maternal and child health. This systematic review aimed to assess the maternal, perinatal and infant health outcomes of women from GRT communities and the factors associated with the reported outcomes. METHODS Database searches were conducted from inception to June 2023 in 4 bibliographic databases supplemented with an additional Google Scholar search. Studies with quantitative data on maternal outcomes published in English were considered. A narrative synthesis was performed, and data were presented in text, figures and tables. FINDINGS Forty-five studies from 13 European countries were included. Outcome factors related to mothers showing low healthcare engagement, high fertility rates and shorter gestation periods among GRT women. Child wantedness was also noted to influence pregnancy completeness, which included abortion and miscarriage. More negative infant outcomes were seen in GRT infants than non-GRT infants; this included higher preterm births, lower birth weight, higher rates of intrauterine growth restriction and infant mortality. Risk factors of poorer maternal outcomes were early reproduction, education, smoking, alcohol consumption, deprivation, poor nutrition and perinatal care. CONCLUSION This review provides evidence that GRT women and children experience more negative outcomes than general populations. It also highlights the gaps in ethnicity and health inequalities more broadly. The significant importance of this research is the need for increased focus on reducing health inequalities, especially among the GRT community.
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Affiliation(s)
- Winifred Ekezie
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, United Kingdom; Centre for Ethnic Health Research, University of Leicester, Leicester LE5 4PW, United Kingdom; School of Social Sciences and Humanities, Aston University, Birmingham B4 7ET, United Kingdom.
| | - Ellen Hopwood
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, United Kingdom; Department of Population Health Sciences, University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Barbara Czyznikowska
- Centre for Ethnic Health Research, University of Leicester, Leicester LE5 4PW, United Kingdom
| | - Sarah Weidman
- Leicester Institute for Advanced Studies (LIAS), University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Nicola Mackintosh
- Department of Population Health Sciences, University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Ffion Curtis
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, United Kingdom; Centre for Ethnic Health Research, University of Leicester, Leicester LE5 4PW, United Kingdom; Institute of Population Health, Liverpool Reviews and Implementation Group (LRiG), University of Liverpool, Liverpool L69 3GF, United Kingdom
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10
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Wahabi H, Elmorshedy H, Amer YS, Saeed E, Razak A, Hamama IA, Hadid A, Ahmed S, Aleban SA, Aldawish RA, Alyahiwi LS, Alnafisah HA, AlSubki RE, Albahli NK, Almutairi AA, Alsanad LF, Fayed A. Neonatal Birthweight Spectrum: Maternal Risk Factors and Pregnancy Outcomes in Saudi Arabia. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:193. [PMID: 38399481 PMCID: PMC10890056 DOI: 10.3390/medicina60020193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/29/2023] [Accepted: 01/15/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Low-birth-weight (LBW) neonates are at increased risk of morbidity and mortality which are inversely proportional to birth weight, while macrosomic babies are at risk of birth injuries and other related complications. Many maternal risk factors were associated with the extremes of birthweight. The objectives of this study are to investigate maternal risk factors for low and high birthweight and to report on the neonatal complications associated with abnormal birth weights. Materials and Methods: We conducted a retrospective analysis of medical records of deliveries ≥ 23 weeks. We classified the included participants according to birth weight into normal birth weight (NBW), LBW, very LBW (VLBW), and macrosomia. The following maternal risk factors were included, mother's age, parity, maternal body mass index (BMI), maternal diabetes, and hypertension. The neonatal outcomes were APGAR scores < 7, admission to neonatal intensive care unit (NICU), respiratory distress (RD), and hyperbilirubinemia. Data were analyzed using SAS Studio, multivariable logistic regression analyses were used to investigate the independent effect of maternal risk factors on birthweight categories and results were reported as an adjusted odds ratio (aOR) and 95% Confidence Interval (CI). Results: A total of 1855 were included in the study. There were 1638 neonates (88.3%) with NBW, 153 (8.2%) with LBW, 27 (1.5%) with VLBW, and 37 (2.0%) with macrosomia. LBW was associated with maternal hypertension (aOR = 3.5, 95% CI = 1.62-7.63), while increasing gestational age was less likely associated with LBW (aOR = 0.51, 95% CI = 0.46-0.57). Macrosomia was associated with maternal diabetes (aOR = 3.75, 95% CI = 1.67-8.41), in addition to maternal obesity (aOR = 3.18, 95% CI = 1.24-8.14). The odds of VLBW were reduced significantly with increasing gestational age (aOR = 0.41, 95% CI = 0.32-0.53). In total, 81.5% of VLBW neonates were admitted to the NICU, compared to 47.7% of LBW and 21.6% of those with macrosomia. RD was diagnosed in 59.3% of VLBW neonates, in 23% of LBW, in 2.7% of macrosomic and in 3% of normal-weight neonates. Hyperbilirubinemia was reported in 37.04%, 34.21%, 22.26%, and 18.92% of VLBW, LBW, NBW, and macrosomic newborns, respectively. Conclusions: Most neonates in this study had normal birthweights. Maternal hypertension and lower gestational age were associated with increased risk of LBW. Additionally, maternal obesity and diabetes increased the risk of macrosomia. Neonatal complications were predominantly concentrated in the LBW and VLBW, with a rising gradient as birthweight decreased. The main complications included respiratory distress and NICU admissions.
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Affiliation(s)
- Hayfaa Wahabi
- Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh 11451, Saudi Arabia; (H.W.); (Y.S.A.); (S.A.)
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
| | - Hala Elmorshedy
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria 5424041, Egypt;
| | - Yasser S. Amer
- Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh 11451, Saudi Arabia; (H.W.); (Y.S.A.); (S.A.)
- Clinical Practice Guidelines and Quality Research Unit, Corporate Quality Management Department, King Saud University Medical City, Riyadh 11451, Saudi Arabia
| | - Elshazaly Saeed
- Prince Abdulla Bin Khaled Coeliac Disease Research Chair, Department of Pediatrics, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Abdul Razak
- Neonatal Intensive Care Unit, Department of Pediatrics, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia; (A.R.); (I.A.H.)
| | - Ibrahim Abdelaziz Hamama
- Neonatal Intensive Care Unit, Department of Pediatrics, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia; (A.R.); (I.A.H.)
| | - Adnan Hadid
- Neonatal Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, Riyadh 11451, Saudi Arabia;
| | - Samia Ahmed
- Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh 11451, Saudi Arabia; (H.W.); (Y.S.A.); (S.A.)
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
| | - Sarah A. Aleban
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia; (S.A.A.); (R.A.A.); (L.S.A.); (H.A.A.); (R.E.A.); (N.K.A.); (A.A.A.)
| | - Reema Abdullah Aldawish
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia; (S.A.A.); (R.A.A.); (L.S.A.); (H.A.A.); (R.E.A.); (N.K.A.); (A.A.A.)
| | - Lara Sabri Alyahiwi
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia; (S.A.A.); (R.A.A.); (L.S.A.); (H.A.A.); (R.E.A.); (N.K.A.); (A.A.A.)
| | - Haya Abdullah Alnafisah
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia; (S.A.A.); (R.A.A.); (L.S.A.); (H.A.A.); (R.E.A.); (N.K.A.); (A.A.A.)
| | - Raghad E. AlSubki
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia; (S.A.A.); (R.A.A.); (L.S.A.); (H.A.A.); (R.E.A.); (N.K.A.); (A.A.A.)
| | - Norah Khalid Albahli
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia; (S.A.A.); (R.A.A.); (L.S.A.); (H.A.A.); (R.E.A.); (N.K.A.); (A.A.A.)
| | - Aljohara Ayed Almutairi
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia; (S.A.A.); (R.A.A.); (L.S.A.); (H.A.A.); (R.E.A.); (N.K.A.); (A.A.A.)
| | | | - Amel Fayed
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia; (S.A.A.); (R.A.A.); (L.S.A.); (H.A.A.); (R.E.A.); (N.K.A.); (A.A.A.)
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11
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Hazlehurst MF, Sathyanarayana S. Invited Perspective: Prenatal PM2.5 Exposure Associated with Adverse Birth Outcomes Requiring Medical Interventions. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:11303. [PMID: 38271059 PMCID: PMC10810298 DOI: 10.1289/ehp14290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
Affiliation(s)
- Marnie F. Hazlehurst
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, Washington, USA
- Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Sheela Sathyanarayana
- Seattle Children’s Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
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12
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Ismail L, Markowsky A, Adusei-Baah C, Gallizzi G, Hall M, Kalburgi S, McQuistion K, Morgan J, Tamaskar N, Parikh K. Variation in Length of Stay by Level of Neonatal Care Among Moderate and Late Preterm Infants. Hosp Pediatr 2024; 14:37-44. [PMID: 38058236 DOI: 10.1542/hpeds.2023-007252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Moderate and late preterm infants are a growing subgroup of neonates with increased care needs after birth, yet standard protocols are lacking. We aim to describe variation in length of stay (LOS) by gestational age (GA) across hospitals within the same level of neonatal care and between different levels of neonatal care. METHODS Retrospective cohort study of hospitalizations for moderate (32-33 weeks GA) and late (34-36 weeks GA) preterm infants in 2019 Kid's Inpatient Database. We compared adjusted LOS in this cohort and evaluated variation within hospitals of the same level and across different levels of neonatal care. RESULTS This study includes 217 051 moderate (26.2%) and late (73.8%) preterm infants from level II (19.7%), III (66.3%), and IV (11.1%) hospitals. Patient-level (race and ethnicity, primary payor, delivery type, multiple gestation, birth weight) and hospital-level (birth region, level of neonatal care) factors were significantly associated with LOS. Adjusted mean LOS varied for hospitals within the same level of neonatal care with level II hospitals showing the greatest variability among 34- to 36- week GA infants when compared with level III and IV hospitals (P < .01). LOS also varied significantly between levels of neonatal care with the greatest variation (0.9 days) seen in 32-week GA between level III and level IV hospitals. CONCLUSIONS For moderate and late preterm infants, the level of neonatal care was associated with variation in LOS after adjusting for clinical severity. Hospitals providing level II neonatal care showed the greatest variation and may provide an opportunity to standardize care.
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Affiliation(s)
- Lana Ismail
- Children's National Hospital, Washington, District of Columbia
| | | | | | - Gina Gallizzi
- Children's National Hospital, Washington, District of Columbia
| | | | - Sonal Kalburgi
- Children's National Hospital, Washington, District of Columbia
| | | | - Joy Morgan
- Children's National Hospital, Washington, District of Columbia
| | - Nisha Tamaskar
- Children's National Hospital, Washington, District of Columbia
| | - Kavita Parikh
- Children's National Hospital, Washington, District of Columbia
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13
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Gaffar S, Ramanathan R, Easterlin MC. Common Clinical Scenarios of Systemic Hypertension in the NICU. Neoreviews 2024; 25:e36-e49. [PMID: 38161177 DOI: 10.1542/neo.25-1-e36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Hypertension affects ∼1% to 3% of newborns in the NICU. However, the identification and management of hypertension can be challenging because of the lack of data-driven diagnostic criteria and management guidelines. In this review, we summarize the most recent approaches to diagnosis, evaluation, and treatment of hypertension in neonates and infants. We also identify common clinical conditions in neonates in whom hypertension occurs, such as renal vascular and parenchymal disease, bronchopulmonary dysplasia, and cardiac conditions, and address specific considerations for the evaluation and treatment of hypertension in those conditions. Finally, we discuss the importance of ongoing monitoring and long-term follow-up of infants diagnosed with hypertension.
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Affiliation(s)
- Sheema Gaffar
- Division of Neonatology, Department of Pediatrics, Los Angeles General Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Division of Neonatology, Fetal and Neonatal Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Rangasamy Ramanathan
- Division of Neonatology, Department of Pediatrics, Los Angeles General Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Molly Crimmins Easterlin
- Division of Neonatology, Fetal and Neonatal Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
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14
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Oh J, Buckley JP, Li X, Gachigi KK, Kannan K, Lyu W, Ames JL, Barrett ES, Bastain TM, Breton CV, Buss C, Croen LA, Dunlop AL, Ferrara A, Ghassabian A, Herbstman JB, Hernandez-Castro I, Hertz-Picciotto I, Kahn LG, Karagas MR, Kuiper JR, McEvoy CT, Meeker JD, Morello-Frosch R, Padula AM, Romano ME, Sathyanarayana S, Schantz S, Schmidt RJ, Simhan H, Starling AP, Tylavsky FA, Volk HE, Woodruff TJ, Zhu Y, Bennett DH. Associations of Organophosphate Ester Flame Retardant Exposures during Pregnancy with Gestational Duration and Fetal Growth: The Environmental influences on Child Health Outcomes (ECHO) Program. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:17004. [PMID: 38262621 PMCID: PMC10805613 DOI: 10.1289/ehp13182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Widespread exposure to organophosphate ester (OPE) flame retardants with potential reproductive toxicity raises concern regarding the impacts of gestational exposure on birth outcomes. Previous studies of prenatal OPE exposure and birth outcomes had limited sample sizes, with inconclusive results. OBJECTIVES We conducted a collaborative analysis of associations between gestational OPE exposures and adverse birth outcomes and tested whether associations were modified by sex. METHODS We included 6,646 pregnant participants from 16 cohorts in the Environmental influences on Child Health Outcomes (ECHO) Program. Nine OPE biomarkers were quantified in maternal urine samples collected primarily during the second and third trimester and modeled as log 2 -transformed continuous, categorized (high/low/nondetect), or dichotomous (detect/nondetect) variables depending on detection frequency. We used covariate-adjusted linear, logistic, and multinomial regression with generalized estimating equations, accounting for cohort-level clustering, to estimate associations of OPE biomarkers with gestational length and birth weight outcomes. Secondarily, we assessed effect modification by sex. RESULTS Three OPE biomarkers [diphenyl phosphate (DPHP), a composite of dibutyl phosphate and di-isobutyl phosphate (DBUP/DIBP), and bis(1,3-dichloro-2-propyl) phosphate] were detected in > 85 % of participants. In adjusted models, DBUP/DIBP [odds ratio (OR) per doubling = 1.07 ; 95% confidence interval (CI): 1.02, 1.12] and bis(butoxyethyl) phosphate (OR for high vs. nondetect = 1.25 ; 95% CI: 1.06, 1.46), but not other OPE biomarkers, were associated with higher odds of preterm birth. We observed effect modification by sex for associations of DPHP and high bis(2-chloroethyl) phosphate with completed gestational weeks and odds of preterm birth, with adverse associations among females. In addition, newborns of mothers with detectable bis(1-chloro-2-propyl) phosphate, bis(2-methylphenyl) phosphate, and dipropyl phosphate had higher birth weight-for-gestational-age z -scores (β for detect vs. nondetect = 0.04 - 0.07 ); other chemicals showed null associations. DISCUSSION In the largest study to date, we find gestational exposures to several OPEs are associated with earlier timing of birth, especially among female neonates, or with greater fetal growth. https://doi.org/10.1289/EHP13182.
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Affiliation(s)
- Jiwon Oh
- Department of Public Health Sciences, University of California Davis (UC-Davis), Davis, California, USA
| | - Jessie P. Buckley
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill (UNC-Chapel Hill), Chapel Hill, North Carolina, USA
| | - Xuan Li
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kennedy K. Gachigi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kurunthachalam Kannan
- Wadsworth Center, Division of Environmental Health Sciences, New York State Department of Health, Albany, New York, USA
- Department of Environmental Health Sciences, University at Albany, State University of New York, Albany, New York, USA
| | - Wenjie Lyu
- Department of Pediatrics, New York University (NYU) Grossman School of Medicine, New York, New York, USA
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Jennifer L. Ames
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Emily S. Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
- Environmental and Occupational Health Sciences Institute, Rutgers, the State University of New Jersey, Piscataway, New Jersey, USA
| | - Theresa M. Bastain
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Carrie V. Breton
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Claudia Buss
- Department of Medical Psychology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Pediatrics, UC-Irvine School of Medicine, Orange, California, USA
| | - Lisa A. Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Anne L. Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Akhgar Ghassabian
- Department of Pediatrics, New York University (NYU) Grossman School of Medicine, New York, New York, USA
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, New York, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Julie B. Herbstman
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Ixel Hernandez-Castro
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Irva Hertz-Picciotto
- Department of Public Health Sciences, University of California Davis (UC-Davis), Davis, California, USA
- Medical Investigations of Neurodevelopmental Disorders Institute, UC-Davis, Sacramento, California, USA
| | - Linda G. Kahn
- Department of Pediatrics, New York University (NYU) Grossman School of Medicine, New York, New York, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Margaret R. Karagas
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Jordan R. Kuiper
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cindy T. McEvoy
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - John D. Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Rachel Morello-Frosch
- Department of Environmental Science, Policy and Management and School of Public Health, UC-Berkeley, Berkeley, California, USA
| | - Amy M. Padula
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Megan E. Romano
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Sheela Sathyanarayana
- Department of Pediatrics, University of Washington and Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Susan Schantz
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Rebecca J. Schmidt
- Department of Public Health Sciences, University of California Davis (UC-Davis), Davis, California, USA
- Medical Investigations of Neurodevelopmental Disorders Institute, UC-Davis, Sacramento, California, USA
| | - Hyagriv Simhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Anne P. Starling
- Department of Epidemiology, Gillings School of Global Public Health, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
- Center for Lifecourse Epidemiology of Adiposity and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Frances A. Tylavsky
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Heather E. Volk
- Department of Mental Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tracey J. Woodruff
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Deborah H. Bennett
- Department of Public Health Sciences, University of California Davis (UC-Davis), Davis, California, USA
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15
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包 梦, 乔 秀, 张 新, 张 子, 赵 菲, 陈 新. [Neuropsychological development of large for gestational age infants at the age of 12 months]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:1246-1252. [PMID: 38112142 PMCID: PMC10731971 DOI: 10.7499/j.issn.1008-8830.2307040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/27/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVES To investigate the level of neuropsychological development in large for gestational age (LGA) infants at the age of 12 months. METHODS The infants, aged 12 to <13 months, who attended the Outpatient Service of Child Care in the First Affiliated Hospital of Shandong First Medical University from December 2021 to June 2023, were enrolled as subjects. According to the gestational age and birth weight, they were divided into preterm appropriate for gestational age (AGA) group, preterm LGA group, early term AGA group, early term LGA group, full-term AGA group, and full-term LGA group. A modified Poisson regression analysis was used to investigate the association between LGA and neuropsychological development outcome at 12 months of age. RESULTS After adjustment for confounding factors, compared with the full-term AGA group at the age of 12 months, the full-term LGA group had a significant increase in the risk of language deficit (RR=1.364, 95%CI: 1.063-1.750), the early term LGA group had significant increases in the risk of abnormal gross motor, fine motor, language, and the preterm LGA group had significant increases in the risk of abnormal language, social behavior, and total developmental quotient (P<0.05); also, the early term AGA group had higher risks of developmental delay across all five attributes and in total developmental quotient at the age of 12 months (P<0.05); except for the language attribute, the preterm AGA group had higher risks of developmental delay in the other 4 attributes (P<0.05). CONCLUSIONS The neuropsychological development of LGA infants with different gestational ages lags behind that of full-term AGA infants at 12 months of age, and follow-up and early intervention of such infants should be taken seriously in clinical practice.
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Affiliation(s)
| | - 秀芸 乔
- 山东第一医科大学第一附属医院/山东省千佛山医院护理部,山东济南250013
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16
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Macias R, Peterson D, Korkis L, Edson R, Gall R. Prevalence and Impact of Feeding-Related Events on Hospital Stay in Preterm and Term Newborns. Adv Neonatal Care 2023; 23:541-546. [PMID: 37862366 DOI: 10.1097/anc.0000000000001115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
BACKGROUND Nursing assessment of milk flow regulation and associated apnea, bradycardia, and desaturation (ABD events) contribute to considerations for the discharge of newborns from the acute care setting. Research regarding infant feeding-related (FR) events (sucking and swallowing difficulties) and ABD events in moderate to late-preterm and full-term infants is lacking. PURPOSE This study observes the impact of FR and ABD events during feeding on hospital length of stay (LOS) and healthcare utilization (cost) in moderate-to-late preterm newborns, as well as full-term infants. METHODS In a retrospective study, bottle-fed infants admitted to the level II specialty care nursery of an academic community hospital in Southern California were observed for FR and ABD events. Statistical analyses were used to determine the impact of FR events on adjusted LOS, to evaluate the interaction between FR event status and adjusted LOS on total hospital charges, and to assess the statistical independence between FR events and diagnostic-related group severity. RESULTS The full sample of patient records included 308 infants born between 32- and 44-week gestational age between April 1, 2018, and October 31, 2022. LOS was twice as long in infants who had FR events. Total median charges were higher in the group with FR events at $160,165 versus $64,380 with non-FR events. IMPLICATIONS FOR PRACTICE AND RESEARCH Increased knowledge in the epidemiology and nursing care of infants experiencing milk flow regulation and associated ABD events is critical for informing practices and guidelines related to the prevention of related morbidities.
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Dunlop AL, Burjak M, Dean LT, Alshawabkeh AN, Avalos LA, Aschner JL, Breton CV, Charifson MA, Cordero J, Dabelea D, D’Sa V, Duarte CS, Elliott AJ, Eick SM, Ferrara A, Fichorova RN, Ganiban JM, Gern JE, Hedderson MM, Herbstman JB, Hipwell AE, Huddleston KC, Karagas M, Karr C, Kerver JM, Koinis-Mitchell D, Lyall K, Madan J, Marsit C, McEvoy CT, Meeker JD, Oken E, O’Shea TM, Padula AM, Sathyanarayana S, Schantz S, Schmidt RJ, Snowden J, Stanford JB, Weiss S, Wright RO, Wright RJ, Zhang X, McGrath M. Association of maternal education, neighborhood deprivation, and racial segregation with gestational age at birth by maternal race/ethnicity and United States Census region in the ECHO cohorts. Front Public Health 2023; 11:1165089. [PMID: 38098826 PMCID: PMC10719953 DOI: 10.3389/fpubh.2023.1165089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 10/13/2023] [Indexed: 12/17/2023] Open
Abstract
Background In the United States, disparities in gestational age at birth by maternal race, ethnicity, and geography are theorized to be related, in part, to differences in individual- and neighborhood-level socioeconomic status (SES). Yet, few studies have examined their combined effects or whether associations vary by maternal race and ethnicity and United States Census region. Methods We assembled data from 34 cohorts in the Environmental influences on Child Health Outcomes (ECHO) program representing 10,304 participants who delivered a liveborn, singleton infant from 2000 through 2019. We investigated the combined associations of maternal education level, neighborhood deprivation index (NDI), and Index of Concentration at the Extremes for racial residential segregation (ICERace) on gestational weeks at birth using linear regression and on gestational age at birth categories (preterm, early term, post-late term relative to full term) using multinomial logistic regression. Results After adjustment for NDI and ICERace, gestational weeks at birth was significantly lower among those with a high school diploma or less (-0.31 weeks, 95% CI: -0.44, -0.18), and some college (-0.30 weeks, 95% CI: -0.42, -0.18) relative to a master's degree or higher. Those with a high school diploma or less also had an increased odds of preterm (aOR 1.59, 95% CI: 1.20, 2.10) and early term birth (aOR 1.26, 95% CI: 1.05, 1.51). In adjusted models, NDI quartile and ICERace quartile were not associated with gestational weeks at birth. However, higher NDI quartile (most deprived) associated with an increased odds of early term and late term birth, and lower ICERace quartile (least racially privileged) associated with a decreased odds of late or post-term birth. When stratifying by region, gestational weeks at birth was lower among those with a high school education or less and some college only among those living in the Northeast or Midwest. When stratifying by race and ethnicity, gestational weeks at birth was lower among those with a high school education or less only for the non-Hispanic White category. Conclusion In this study, maternal education was consistently associated with shorter duration of pregnancy and increased odds of preterm birth, including in models adjusted for NDI and ICERace.
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Affiliation(s)
- Anne L. Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Mohamad Burjak
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Lorraine T. Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Akram N. Alshawabkeh
- Department of Civil and Environmental Engineering, College of Engineering, Northeastern University, Boston, MA, United States
| | - Lyndsay A. Avalos
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Judy L. Aschner
- Albert Einstein College of Medicine, Bronx, NY, United States
- Hackensack Meridian School of Medicine, Nutley, NJ, United States
| | - Carrie V. Breton
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, United States
| | - Mia A. Charifson
- Division of Epidemiology, New York University Langone Health Grossman School of Medicine, New York, NY, United States
| | - Jose Cordero
- Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, Athens, GA, United States
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Viren D’Sa
- Department of Pediatrics, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Cristiane S. Duarte
- Division of Child and Adolescent Psychiatry, Columbia University-New York State Psychiatric Institute, New York, NY, United States
| | - Amy J. Elliott
- Avera Research Institute, Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, United States
| | - Stephanie M. Eick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Raina N. Fichorova
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Jody M. Ganiban
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, United States
| | - James E. Gern
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Monique M. Hedderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Julie B. Herbstman
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Alison E. Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kathi C. Huddleston
- College of Health and Human Services, George Mason University, Fairfax, VA, United States
| | - Margaret Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Catherine Karr
- Departments of Pediatrics and Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States
| | - Jean M. Kerver
- Departments of Epidemiology and Biostatistics and Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Daphne Koinis-Mitchell
- Department of Pediatrics, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Kristen Lyall
- AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, United States
| | - Juliette Madan
- Department of Epidemiology, Pediatrics and Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Carmen Marsit
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Cindy T. McEvoy
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, United States
| | - John D. Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - T. Michael O’Shea
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Amy M. Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Sheela Sathyanarayana
- Departments of Pediatrics and Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States
| | - Susan Schantz
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Rebecca J. Schmidt
- Department of Public Health Sciences, MIND Institute, University of California, Davis, Davis, CA, United States
| | - Jessica Snowden
- Departments of Pediatrics and Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Joseph B. Stanford
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Scott Weiss
- Department of Medicine, Harvard School of Medicine, Boston, MA, United States
| | - Robert O. Wright
- Department of Pediatrics, The Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Rosalind J. Wright
- Department of Pediatrics, The Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Xueying Zhang
- Department of Pediatrics, The Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Monica McGrath
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Shah MD. Discontinuing Predischarge Car Seat Tolerance Tests: Is It Too Premature? J Pediatr 2023; 262:113663. [PMID: 37541426 DOI: 10.1016/j.jpeds.2023.113663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/01/2023] [Indexed: 08/06/2023]
Affiliation(s)
- Malika D Shah
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
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Frakking TT, Whillans C, Rogash C, David M. Properties of Australian thickened formulae for infants and children: Influence of preparation and nutritional content on IDDSI properties. J Texture Stud 2023; 54:736-744. [PMID: 37086024 DOI: 10.1111/jtxs.12762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/03/2023] [Accepted: 04/08/2023] [Indexed: 04/23/2023]
Abstract
Between 30% and 50% of infants and children with pediatric feeding disorders demonstrate oropharyngeal aspiration. Thickening fluids are a compensatory strategy that is commonly recommended by speech pathologists for the management of oropharyngeal aspiration. Ongoing variability in the preparation of thickened fluids across infant formulas and healthcare facilities continue to limit the standardization of the preparation of thickened infant and pediatric formulas. No studies exist which examine the influence of nutritional properties of different infant formula types on IDDSI thickness levels. Our study aimed to describe the impact of standardized resting times; and understand the influence of nutritional properties on a variety of ready-to-feed liquid and powder-based Australian thickened formulae. A total of 27 ready-to-feed liquid and powder-based formulas were tested for viscosity level at baseline and when thickener was added on at least two trials. Frequency counts and percentages were used to describe categorical data. Logistic regression was used to model the binary outcome and calculate the odds ratios and their 95% confidence intervals. A total of 18 formulas proceeded to IDDSI flow testing of at least two trials because 7 formulae tested as slightly or mildly thick at baseline; while 2 formulae only had one trial of IDDSI flow testing completed. Of the 18 formulae tested, 72.22% (13/18) of commonly used powder-based and ready-to-feed formulas in Australia thickened to IDDSI slightly thick (level 1) were prepared in a standardized manner and allowed to rest for 5 min. Formulas with higher protein totals were more likely to thicken sufficiently (AOR: 7.45; 95% CI: 2.06-26.89), while formulas with higher sugar totals or those used for enteral feeds were less likely to thicken sufficiently (AOR: 0.02; 95% CI: 0.01-0.29). There was good test-retest reliability (ICC: 0.76; 95% CI: 0.22-0.97), indicating that standardizing the preparation of thickened fluids was consistently achievable. Given that not all formulae were observed to thicken to the intended consistency using standardized preparation and resting time, this study highlights the importance of using the IDDSI Flow Testing Method regularly in practice when recommending thickened infant formula recipes for managing aspiration in infants and children.
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Affiliation(s)
- Thuy T Frakking
- Speech Pathology Department, Gold Coast University Hospital, Southport, Australia
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20
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Yoshida-Montezuma Y, Kirkwood D, Sivapathasundaram B, Keown-Stoneman CDG, de Souza RJ, To T, Borkhoff CM, Birken CS, Maguire JL, Brown HK, Anderson LN. Late preterm birth and growth trajectories during childhood: a linked retrospective cohort study. BMC Pediatr 2023; 23:450. [PMID: 37684561 PMCID: PMC10485950 DOI: 10.1186/s12887-023-04257-x] [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: 03/13/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Evidence suggests that accelerated postnatal growth in children is detrimental for adult cardiovascular health. It is unclear whether children born late preterm (34-36 weeks) compared to full term (≥ 39 weeks), have different growth trajectories. Our objective was to evaluate the association between gestational age groups and growth trajectories of children born between 2006-2014 and followed to 2021 in Ontario, Canada. METHODS We conducted a retrospective cohort study of children from singleton births in TARGet Kids! primary care network with repeated measures of weight and height/length from birth to 14 years, who were linked to health administrative databases. Piecewise linear mixed models were used to model weight (kg/month) and height (cm/month) trajectories with knots at 3, 12, and 84 months. Analyses were conducted based on chronological age. RESULTS There were 4423 children included with a mean of 11 weight and height measures per child. The mean age at the last visit was 5.9 years (Standard Deviation: 3.1). Generally, the more preterm, the lower the mean value of weight and height until early adolescence. Differences in mean weight and height for very/moderate preterm and late preterm compared to full term were evident until 12 months of age. Weight trajectories were similar between children born late preterm and full term with small differences from 84-168 months (mean difference (MD) -0.04 kg/month, 95% CI -0.06, -0.03). Children born late preterm had faster height gain from 0-3 months (MD 0.70 cm/month, 95% CI 0.42, 0.97) and 3-12 months (MD 0.17 cm/month, 95% CI 0.11, 0.22). CONCLUSIONS Compared to full term, children born late preterm had lower average weight and height from birth to 14 years, had a slightly slower rate of weight gain after 84 months and a faster rate of height gain from 0-12 months. Follow-up is needed to determine if growth differences are associated with long-term disease risk.
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Affiliation(s)
- Yulika Yoshida-Montezuma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada
| | | | | | - Charles D G Keown-Stoneman
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON, Canada
| | - Teresa To
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- ICES, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Cornelia M Borkhoff
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Women's College Research Institute, Toronto, ON, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Catherine S Birken
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Jonathon L Maguire
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON, Canada
- Department of Pediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hilary K Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- ICES, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Women's College Research Institute, Toronto, ON, Canada
- Department of Health & Society, University of Toronto Scarborough, Toronto, ON, Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada.
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.
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21
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Solebo AL, Rahi JS. Delayed diagnosis of congenital cataract in preterm infants: Findings from the IoLunder2 cohort study. PLoS One 2023; 18:e0287658. [PMID: 37594953 PMCID: PMC10437972 DOI: 10.1371/journal.pone.0287658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/10/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Early detection is critical to achieving optimal outcomes in children with congenital cataract. We hypothesized that detection of congenital cataract in preterm infants would be delayed compared with term/post-term peers due to delayed delivery of whole population child health interventions. METHODS Secondary analysis of data using a nested case-control study approach in a prospective population-based cohort study. Inclusion criteria comprised children diagnosed with congenital cataract requiring surgical intervention during the first two years of life in UK and Ireland in 2009 and 2010. Association between late detection (after eight weeks post-natal age, ie outside the neonatal and infant eye national screening programme) of cataract and preterm birth (gestational age less than 37 weeks) was assessed using multivariable logistic regression. RESULTS Of 186 children with congenital cataract, 17 children were born preterm (9%, gestational age range 24-37weeks). Neonatal detection occurred in 64/186 (34%), and late detection in 64 children (34%). Late detection was independently associated with premature birth, specifically moderate/late preterm birth (adjusted odds ratio 3.0, 95%CI 1.1 to 8.5). CONCLUSIONS Our findings suggest that, despite enhanced eye surveillance being recommended for those born moderate/late preterm (32+ weeks gestational age, ie not eligible for retinopathy of prematurity screening), congenital cataract is not being effectively detected through the routine screening programme for this vulnerable group. It is necessary to improve the effectiveness of the screening programme, and care must be taken to ensure that competing health care needs of preterm children do not prevent universal child health interventions.
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Affiliation(s)
- Ameenat Lola Solebo
- Population, Practice and Policy Research and Teaching Department, UCL GOS Institute of Child Health, London, United Kingdom
- Ophthalmology Department, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
- Ulverscroft Vision Research Group, UCL GOS Institute of Child Health, University College London, London, United Kingdom
- Population and Data Sciences, Institute of Ophthalmology and National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Jugnoo Sangeeta Rahi
- Population, Practice and Policy Research and Teaching Department, UCL GOS Institute of Child Health, London, United Kingdom
- Ophthalmology Department, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
- Ulverscroft Vision Research Group, UCL GOS Institute of Child Health, University College London, London, United Kingdom
- Population and Data Sciences, Institute of Ophthalmology and National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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Mielewczyk FJ, Boyle EM. Uncharted territory: a narrative review of parental involvement in decision-making about late preterm and early term delivery. BMC Pregnancy Childbirth 2023; 23:526. [PMID: 37464284 DOI: 10.1186/s12884-023-05845-6] [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: 01/18/2023] [Accepted: 07/11/2023] [Indexed: 07/20/2023] Open
Abstract
Almost 30% of live births in England and Wales occur late preterm or early term (LPET) and are associated with increased risks of adverse health outcomes throughout the lifespan. However, very little is known about the decision-making processes concerning planned LPET births or the involvement of parents in these. This aim of this paper is to review the evidence on parental involvement in obstetric decision-making in general, to consider what can be extrapolated to decisions about LPET delivery, and to suggest directions for further research.A comprehensive, narrative review of relevant literature was conducted using Medline, MIDIRS, PsycInfo and CINAHL databases. Appropriate search terms were combined with Boolean operators to ensure the following broad areas were included: obstetric decision-making, parental involvement, late preterm and early term birth, and mode of delivery.This review suggests that parents' preferences with respect to their inclusion in decision-making vary. Most mothers prefer sharing decision-making with their clinicians and up to half are dissatisfied with the extent of their involvement. Clinicians' opinions on the limits of parental involvement, especially where the safety of mother or baby is potentially compromised, are highly influential in the obstetric decision-making process. Other important factors include contextual factors (such as the nature of the issue under discussion and the presence or absence of relevant medical indications for a requested intervention), demographic and other individual characteristics (such as ethnicity and parity), the quality of communication; and the information provided to parents.This review highlights the overarching need to explore how decisions about potential LPET delivery may be reached in order to maximise the satisfaction of mothers and fathers with their involvement in the decision-making process whilst simultaneously enabling clinicians both to minimise the number of LPET births and to optimise the wellbeing of women and babies.
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Affiliation(s)
- Frances J Mielewczyk
- Leicester City Football Club (LCFC) Research Programme, Department of Population Health Sciences, College of Life Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK.
| | - Elaine M Boyle
- Department of Population Health Sciences, College of Life Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK
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23
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Novitskiy N, Chan PHY, Chan M, Lai CM, Leung TY, Leung TF, Bornstein MH, Lam HS, Wong PCM. Deficits in neural encoding of speech in preterm infants. Dev Cogn Neurosci 2023; 61:101259. [PMID: 37257249 DOI: 10.1016/j.dcn.2023.101259] [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: 01/11/2023] [Revised: 05/19/2023] [Accepted: 05/25/2023] [Indexed: 06/02/2023] Open
Abstract
Preterm children show developmental cognitive and language deficits that can be subtle and sometimes undetectable until later in life. Studies of brain development in children who are born preterm have largely focused on vascular and gross anatomical characteristics rather than pathophysiological processes that may contribute to these developmental deficits. Neural encoding of speech as reflected in EEG recordings is predictive of future language development and could provide insights into those pathophysiological processes. We recorded EEG from 45 preterm (≤ 34 weeks of gestation) and 45 term (≥ 38 weeks) Chinese-learning infants 0-12 months of (corrected) age during natural sleep. Each child listened to three speech stimuli that differed in lexically meaningful pitch (2 native and 1 non-native speech categories). EEG measures associated with synchronization and gross power of the frequency following response (FFR) were examined. ANCOVAs revealed no main effect of stimulus nativeness but main effects of age, consistent with earlier studies. A main effect of prematurity also emerged, with synchronization measures showing stronger group differences than power. By detailing differences in FFR measures related to synchronization and power, this study brings us closer to identifying the pathophysiological pathway to often subtle language problems experienced by preterm children.
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Affiliation(s)
- Nikolay Novitskiy
- Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong, China
| | - Peggy H Y Chan
- Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong, China; Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, China
| | - Mavis Chan
- Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong, China
| | - Chin Man Lai
- Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong, China
| | - Tak Yeung Leung
- Department of Obsterics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Ting Fan Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, China
| | - Marc H Bornstein
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, USA; UNICEF, USA; Institute for Fiscal Studies, UK
| | - Hugh S Lam
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, China.
| | - Patrick C M Wong
- Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong, China.
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Hsu TY, Cheng HH, Lan KC, Hung HN, Lai YJ, Tsai CC, Fan WL, Li SC. The abundances of LTF and SOD2 in amniotic fluid are potential biomarkers of gestational age and preterm birth. Sci Rep 2023; 13:4903. [PMID: 36966172 PMCID: PMC10039869 DOI: 10.1038/s41598-023-31486-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 03/13/2023] [Indexed: 03/27/2023] Open
Abstract
Neonates who are born preterm (PT) are usually characterized by immature physiological development, and preterm birth (PTB) is the leading cause of neonatal morbidity and mortality if intensive medical care is not available to PTB neonates. Early prediction of a PTB enables medical personnel to make preparations in advance, protecting the neonate from the subsequent health risks. Therefore, many studies have worked on identifying invasive or noninvasive PT biomarkers. In this study, we collected amniocentesis-derived (at the second trimester of gestation) amniotic fluid (AF) samples. At delivery, AF samples were classified into PTB or full-term birth (FTB). We first applied protein mass spectrometry technology to globally screen AF proteins, followed by specific protein validation with ELISA. We identified four protein biomarkers of PTB, including lactotransferrin (LTF), glutathione-disulfide reductase (GSR), myeloperoxidase (MPO) and superoxide dismutase 2 (SOD2). Further analyses demonstrated that their abundances were negatively correlated with neonatal weight and gestational age. In addition, by mimicking survival rate analysis widely used in tumor biology, we found that LTF and SOD2 were prognostic factors of gestational age, with higher levels denoting shorter gestational age. Finally, using the abundances of the four protein biomarkers, we developed a prediction model of PTB with an auROC value of 0.935 (sensitivity = 0.94, specificity = 0.89, p value = 0.0001). This study demonstrated that the abundances of specific proteins in amniotic fluid were not only the prognostic factors of gestational age but also the predictive biomarkers of PTB. These four AF proteins enable identification of PTB early in the second trimester of gestation, facilitating medical intervention to be applied in advance.
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Affiliation(s)
- Te-Yao Hsu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsin-Hsin Cheng
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Chung Lan
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Obstetrics and Gynecology, Jen-Ai Hospital, Taizhong, Taiwan
| | - Hsuan-Ning Hung
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yun-Ju Lai
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Chang Tsai
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Lang Fan
- Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 12th Floor, Children's Hospital, No.123, Dapi Rd, Niaosong District, Kaohsiung, 83301, Taiwan.
| | - Sung-Chou Li
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, 4th Floor, No.386, Dazhong 1st Rd, Zuoying District, Kaohsiung, 813414, Taiwan.
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Gutzeit O, Justman N, Zvi DB, Siegler Y, Khatib N, Ginsberg Y, Beloosesky R, Weiner Z, Vitner D, Liberman S, Zipori Y. Late preterm delivery has a distinctive second-stage duration and characteristics. Am J Obstet Gynecol MFM 2023; 5:100845. [PMID: 36572106 DOI: 10.1016/j.ajogmf.2022.100845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/06/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Late preterm neonates born between 34.0 and 36.6 weeks' gestation are at increased risk for short- and long-term morbidity and mortality when compared with their term counterparts. Currently, no separate labor curve is available for late preterm births, and this group's optimal duration of the second stage of labor has never been defined separately. OBJECTIVE This study aimed to compare the second stage duration between late preterm and term births. STUDY DESIGN This was a retrospective study from May 2014 until May 2021. Eligible were women with a singleton pregnancy, vertex presentation, spontaneous or induced onset of labor, and those who delivered vaginally beyond 34.0 weeks of gestation. The primary outcome of our study was to compare and characterize the second stage of labor duration between late preterm and term births. RESULTS We analyzed 962 late preterm and 9476 term vaginal deliveries. Women who delivered during the late preterm period were more likely to be multiparous (52.4% vs 45.2%; P<.001) and fewer required oxytocin during labor (41.2% vs 54.4%; P<.001) or used epidural analgesia (75.2% vs 83.6%; P<.001). The overall mean duration of the second stage of labor was significantly shorter in the late preterm period than at term (1.08±1.09 hours vs 1.49±1.22 hours; P<.001). This was even more pronounced for nulliparous women (1.05±1.00 hours vs 2.10±1.17 hours; P<.001). Among multiparous women, epidural use significantly affected the duration of the second stage of labor, and the second stage was relatively longer during the late preterm period than at term in this subgroup (1.16 vs 0.5 hours; P<.001). Using a multivariate Cox regression, variables such as maternal age (hazard ratio, 1.02; 95% confidence interval, 1.01-1.04), parity (hazard ratio, 4.11; 95% confidence interval, 3.65-4.63), preterm birth (hazard ratio, 2.08; 95% confidence interval, 1.4-3.10), and birthweight at delivery (hazard ratio, 1.15; 95% confidence interval, 1.01-1.30) shortened the second stage, whereas induction of labor (hazard ratio, 0.75; 95% confidence interval, 0.66-0.86) and epidural use (hazard ratio, 0.68; 95% confidence interval, 0.64-0.86) extended its total duration. Regardless of parity, lower rates of operative vaginal deliveries were observed in the late preterm period than at term (3.7% vs 15.5%; P<.001). This period was also associated with lower rates of third- and fourth-degree perineal lacerations (0.2% vs 2.2%; P<.001) but higher rates of chorioamnionitis (1.7% vs 0.1%; P<.001), Apgar score at 5 minutes <7 (1.0% vs 0.2%; P<.001), and admission to the neonatal intensive care unit (19.3% vs 1.0%; P<.001). CONCLUSION Women who delivered vaginally during the late preterm period had a distinctive second-stage duration. Primarily, it was shown to be significantly shorter for nulliparous and multiparous women. Future studies should further clarify the optimal duration of this stage in relation to neonatal outcomes at such a vulnerable period.
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Affiliation(s)
- Ola Gutzeit
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gutzeit, Justman, Ben Zvi, Siegler, Khatib, Ginsberg, Beloosesky, Weiner, Vitner, Liberman, and Zipori)
| | - Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gutzeit, Justman, Ben Zvi, Siegler, Khatib, Ginsberg, Beloosesky, Weiner, Vitner, Liberman, and Zipori)
| | - Dikla Ben Zvi
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gutzeit, Justman, Ben Zvi, Siegler, Khatib, Ginsberg, Beloosesky, Weiner, Vitner, Liberman, and Zipori)
| | - Yoav Siegler
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gutzeit, Justman, Ben Zvi, Siegler, Khatib, Ginsberg, Beloosesky, Weiner, Vitner, Liberman, and Zipori)
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gutzeit, Justman, Ben Zvi, Siegler, Khatib, Ginsberg, Beloosesky, Weiner, Vitner, Liberman, and Zipori); Ruth & Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel (Drs Khatib, Ginsberg, Beloosesky, Weiner, Vitner, and Zipori)
| | - Yuval Ginsberg
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gutzeit, Justman, Ben Zvi, Siegler, Khatib, Ginsberg, Beloosesky, Weiner, Vitner, Liberman, and Zipori); Ruth & Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel (Drs Khatib, Ginsberg, Beloosesky, Weiner, Vitner, and Zipori)
| | - Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gutzeit, Justman, Ben Zvi, Siegler, Khatib, Ginsberg, Beloosesky, Weiner, Vitner, Liberman, and Zipori); Ruth & Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel (Drs Khatib, Ginsberg, Beloosesky, Weiner, Vitner, and Zipori)
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gutzeit, Justman, Ben Zvi, Siegler, Khatib, Ginsberg, Beloosesky, Weiner, Vitner, Liberman, and Zipori); Ruth & Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel (Drs Khatib, Ginsberg, Beloosesky, Weiner, Vitner, and Zipori)
| | - Dana Vitner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gutzeit, Justman, Ben Zvi, Siegler, Khatib, Ginsberg, Beloosesky, Weiner, Vitner, Liberman, and Zipori); Ruth & Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel (Drs Khatib, Ginsberg, Beloosesky, Weiner, Vitner, and Zipori)
| | - Sapir Liberman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gutzeit, Justman, Ben Zvi, Siegler, Khatib, Ginsberg, Beloosesky, Weiner, Vitner, Liberman, and Zipori)
| | - Yaniv Zipori
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gutzeit, Justman, Ben Zvi, Siegler, Khatib, Ginsberg, Beloosesky, Weiner, Vitner, Liberman, and Zipori); Ruth & Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel (Drs Khatib, Ginsberg, Beloosesky, Weiner, Vitner, and Zipori).
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Salazar EG, Handley SC, Greenberg LT, Edwards EM, Lorch SA. Association Between Neonatal Intensive Care Unit Type and Quality of Care in Moderate and Late Preterm Infants. JAMA Pediatr 2023; 177:278-285. [PMID: 36648939 PMCID: PMC9857785 DOI: 10.1001/jamapediatrics.2022.5213] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 10/18/2022] [Indexed: 01/18/2023]
Abstract
Importance A higher level of care improves outcomes in extremely and very preterm infants, yet the impact of neonatal intensive care unit (NICU) level on moderate and late preterm (MLP) care quality is unknown. Objective To examine the association between NICU type and care quality in MLP (30-36 weeks' gestation) and extremely and very preterm (25-29 weeks' gestation) infants. Design, Setting, and Participants This cohort study was a prospective analysis of 433 814 premature infants born in 465 US hospitals between January 1, 2016, and December 31, 2020, without anomalies and who survived more than 12 hours and were transferred no more than once. Data were from the Vermont Oxford Network all NICU admissions database. Exposures NICU types were defined as units with ventilation restrictions without surgery (type A with restrictions, similar to American Academy of Pediatrics [AAP] level 2 NICUs), without surgery (type A) and with surgery not requiring cardiac bypass (type B, similar to AAP level 3 NICUs), and with all surgery (type C, similar to AAP level 4 NICUs). Main Outcomes and Measures The primary outcome was gestational age (GA)-specific composite quality measures using Baby-Measure of Neonatal Intensive Care Outcomes Research (Baby-MONITOR) for extremely and very preterm infants and an adapted MLP quality measure for MLP infants. Secondary outcomes were individual component measures of each scale. Composite scores were standardized observed minus expected scores, adjusted for patient characteristics, averaged, and expressed with a mean of 0 and SD of 1. Between May 2021 and October 2022, Kruskal-Wallis tests were used to compare scores by NICU type. Results Among the 376 219 MLP (204 181 [54.3%] male, 172 038 [45.7%] female; mean [SD] GA, 34.2 [1.7] weeks) and 57 595 extremely and very preterm (30 173 [52.4%] male, 27 422 [47.6%] female; mean [SD] GA, 27.7 [1.4] weeks) infants included, 6.6% received care in type A NICUs with restrictions, 29.3% in type A NICUs without restrictions, 39.7% in type B NICUs, and 24.4% in type C NICUs. The MLP infants had lower MLP-QM scores in type C NICUs (median [IQR]: type A with restrictions, 0.4 [-0.1 to 0.8]; type A, 0.4 [-0.4 to 0.9]; type B, 0.1 [-0.7 to 0.7]; type C, -0.7 [-1.6 to 0.4]; P < .001). No significant differences were found in extremely and very preterm Baby-MONITOR scores by NICU type. In type C NICUs, MLP infants had lower scores in no extreme length of stay and change-in-weight z score. Conclusions and Relevance In this cohort study, composite quality scores were lower for MLP infants in type C NICUs, whereas extremely and very preterm composite quality scores were similar across NICU types. Policies facilitating care for MLP infants at NICUs with less complex subspecialty services may improve care quality delivered to this prevalent, at-risk population.
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Affiliation(s)
- Elizabeth G. Salazar
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
| | - Sara C. Handley
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Lucy T. Greenberg
- Vermont Oxford Network, Burlington, Vermont
- Department of Mathematics and Statistics, The University of Vermont, Burlington
| | - Erika M. Edwards
- Vermont Oxford Network, Burlington, Vermont
- Department of Mathematics and Statistics, The University of Vermont, Burlington
- Department of Pediatrics, The Robert Larner, MD College of Medicine, The University of Vermont, Burlington
| | - Scott A. Lorch
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Narayanan I, Litch JA, Srinivas GL, Onwona-Agyeman K, Abdul-Mumin A, Ramasethu J. At-Risk Newborns: Overlooked in Expansion From Essential Newborn Care to Small and Sick Newborn Care in Low- and Middle-Income Countries. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:GHSP-D-22-00099. [PMID: 36853638 PMCID: PMC9972386 DOI: 10.9745/ghsp-d-22-00099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023]
Abstract
We propose adding the category of “at-risk” newborns for babies who are at increased risk of morbidity and/or mortality but do not require special or intensive care or monitoring to promote a 3-tiered newborn care approach in hospitals.
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Affiliation(s)
| | - James A. Litch
- Global Alliance to Prevent Prematurity and Stillbirth, Lynnwood, WA, USA
| | - Ganga L. Srinivas
- Case Western Reserve University, ClevelandMedical Center/Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
| | - Kwabena Onwona-Agyeman
- Division of Neonatal Care Unit, Department of Pediatrics, Greater Accra Regional Hospital, Accra, Ghana
| | - Alhassan Abdul-Mumin
- Department of Pediatrics and Child Health, School of Medicine, University for Development Studies; Department of Pediatrics and Child Health, Tamale Teaching Hospital, Tamale, Ghana
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Nurses' Knowledge, Communication Needs, and Future Directions in Neonatal Research: Results of an International Survey. Adv Neonatal Care 2023:00149525-990000000-00051. [PMID: 36735748 PMCID: PMC10371058 DOI: 10.1097/anc.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Preterm birth is a significant contributor to neonatal morbidity and mortality. Despite legislative efforts to increase pediatric drug development, neonatal clinical trials continue to be infrequent. The International Neonatal Consortium (INC) includes nurses as key stakeholders in their mission to accelerate safe and effective therapies for neonates. PURPOSE INC developed a survey for nurses, physicians, and parents to explore communication practices and stakeholders' perceptions and knowledge regarding clinical trials in neonatal intensive care units (NICUs). METHODS A stepwise consensus approach was used to solicit responses to an online survey. The convenience sample was drawn from INC organizations representing the stakeholder groups. Representatives from the National Association of Neonatal Nurses and the Council of International Neonatal Nurses, Inc, participated in all stages of the survey development process, results analysis, and publication of results. RESULTS Participants included 188 nurses or nurse practitioners, mainly from the United States, Canada, the European Union, and Japan; 68% indicated some level of research involvement. Nurses expressed a lack of effective education to prepare them for participation in research. Results indicated a lack of a central information source for staff and systematic approaches to inform families of studies. The majority of nurses indicated they were not asked to provide input into clinical trials. Nurses were uncertain about research consent and result disclosure processes. IMPLICATIONS FOR PRACTICE AND RESEARCH This study indicates the need to educate nurses in research, improve NICU research communication through standardized, systematic pathways, and leverage nurse involvement to enhance research communication.
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de Castro KN, Benson JD, Thomas H, Manuel V, Mitra S. Feasibility of Implementing a Modified SENSE Program to Increase Positive Sensory Experiences for Preterm Infants in the Neonatal Intensive Care Unit (NICU): A Pilot Study. Phys Occup Ther Pediatr 2023; 43:109-128. [PMID: 35903855 DOI: 10.1080/01942638.2022.2104150] [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] [Indexed: 12/15/2022]
Abstract
AIMS To evaluate the feasibility of implementing the Supporting and Enhancing NICU Sensory Experiences (SENSE) program with adaptations to increase positive sensory exposure for infants born preterm, support neonatal neurodevelopment, and decrease parent stress. METHODS Eight infants born between 28 and 33 weeks were recruited within one week of birth. Parents, trained in the program, delivered the SENSE protocol. The first author provided up to 1 h of sensory input on weekdays when a parent could not be present. RESULTS Recruitment and retention rates were 87.5% and 100%, respectively. Recruitment and initial parent education and training averaged 37.5 min. On average, parents were present in the NICU 85.1% of days; they participated in SENSE for an average of 515.5 min. SENSE dose recommendations were not consistently met. Weekly infant assessments and regular parent check ins averaged 22.5 and 13.8 min, respectively. Post-assessments revealed normal scores on a neurodevelopmental assessment, low parent stress, and high parent satisfaction. CONCLUSIONS The recruitment and retention rates suggest high demand to participate. Outcomes for parent stress and neonatal neurodevelopment support continuation of SENSE. Time commitment for implementation, coupled with supporting families in meeting dose recommendations, suggest a need for a neonatal therapist to promote sustainability.
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Affiliation(s)
| | - Jeryl D Benson
- Department of Occupational Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Hillary Thomas
- West Penn Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Vinit Manuel
- West Penn Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Sanjay Mitra
- West Penn Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
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Pournami F, Rugmini S, Prithvi A, Nandakumar A, Prabhakar J, Jain N. Revisiting the use of antenatal corticosteroids for late preterm and early term infants: An observational analytical study. JOURNAL OF CURRENT RESEARCH IN SCIENTIFIC MEDICINE 2023. [DOI: 10.4103/jcrsm.jcrsm_75_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
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Paquette AG, MacDonald J, Bammler T, Day DB, Loftus CT, Buth E, Mason WA, Bush NR, Lewinn KZ, Marsit C, Litch JA, Gravett M, Enquobahrie DA, Sathyanarayana S. Placental transcriptomic signatures of spontaneous preterm birth. Am J Obstet Gynecol 2023; 228:73.e1-73.e18. [PMID: 35868418 PMCID: PMC9790028 DOI: 10.1016/j.ajog.2022.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 07/01/2022] [Accepted: 07/09/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Spontaneous preterm birth accounts for most preterm births and leads to significant morbidity in the newborn and childhood period. This subtype of preterm birth represents an increasing proportion of all preterm births when compared with medically indicated preterm birth, yet it is understudied in omics analyses. The placenta is a key regulator of fetal and newborn health, and the placental transcriptome can provide insight into pathologic changes that lead to spontaneous preterm birth. OBJECTIVE This analysis aimed to identify genes for which placental expression was associated with spontaneous preterm birth (including early preterm and late preterm birth). STUDY DESIGN The ECHO PATHWAYS consortium extracted RNA from placental samples collected from the Conditions Affecting Neurocognitive Development and Learning in Early Childhood and the Global Alliance to Prevent Prematurity and Stillbirth studies. Placental transcriptomic data were obtained by RNA sequencing. Linear models were fit to estimate differences in placental gene expression between term birth and spontaneous preterm birth (including gestational age subgroups defined by the American College of Obstetricians and Gynecologists). Models were adjusted for numerous confounding variables, including labor status, cohort, and RNA sequencing batch. This analysis excluded patients with induced labor, chorioamnionitis, multifetal gestations, or medical indications for preterm birth. Our combined cohort contained gene expression data for 14,023 genes in 48 preterm and 540 term samples. Genes and pathways were considered statistically significantly different at false discovery rate-adjusted P value of <.05. RESULTS In total, we identified 1728 genes for which placental expression was associated with spontaneous preterm birth with more differences in expression in early preterm samples than late preterm samples when compared with full-term samples. Of those, 9 genes were significantly decreased in both early and late spontaneous preterm birth, and the strongest associations involved placental expression of IL1B, ALPL, and CRLF1. In early and late preterm samples, we observed decreased expression of genes involved in immune signaling, signal transduction, and endocrine function. CONCLUSION This study provides a comprehensive assessment of the differences in the placental transcriptome associated with spontaneous preterm birth with robust adjustment for confounding. Results of this study are in alignment with the known etiology of spontaneous preterm birth, because we identified multiple genes and pathways for which the placental and chorioamniotic membrane expression was previously associated with prematurity, including IL1B. We identified decreased expression in key signaling pathways that are essential for placental growth and function, which may be related to the etiology of spontaneous preterm birth. We identified increased expression of genes within metabolic pathways associated exclusively with early preterm birth. These signaling and metabolic pathways may provide clinically targetable pathways and biomarkers. The findings presented here can be used to understand underlying pathologic changes in premature placentas, which can inform and improve clinical obstetrics practice.
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Affiliation(s)
- Alison G Paquette
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, WA; Department of Pediatrics, University of Washington, Seattle, WA.
| | - James MacDonald
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA
| | - Theo Bammler
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA
| | - Drew B Day
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA
| | - Christine T Loftus
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA
| | - Erin Buth
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA
| | - W Alex Mason
- Department of Preventative Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Nicole R Bush
- Department of Psychiatry and Behavioral Sciences, University of San Francisco, San Francisco, CA; Department of Pediatrics, University of San Francisco, San Francisco, CA
| | - Kaja Z Lewinn
- Department of Psychiatry and Behavioral Sciences, University of San Francisco, San Francisco, CA
| | - Carmen Marsit
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA
| | - James A Litch
- Global Alliance to Prevent Preterm Birth and Stillbirth (GAPPS), Lynnwood, WA
| | - Michael Gravett
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | | | - Sheela Sathyanarayana
- Department of Pediatrics, University of Washington, Seattle, WA; Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA; Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA
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32
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York JR, Testa G, Gunby RT, Putman JM, McKenna GJ, Koon EC, Bayer J, Zhang L, Gregg AR, Johannesson L. Neonatal Outcomes after Uterus Transplantation: Dallas Uterus Transplant Study. Am J Perinatol 2023; 40:42-50. [PMID: 33878776 DOI: 10.1055/s-0041-1727212] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Limited data are available on the outcome of infants born after uterus transplantation. Our aim was to describe the hospital course and laboratory findings in the first 2 months of life of the 12 infants born in the Dallas UtErus Transplant Study (DUETS). STUDY DESIGN Based on the trial protocol, information about infants was collected in a prospective fashion, including infant demographics, hospital course, and laboratory values. RESULTS Twelve infants were delivered, all by cesarean section, from 11 mothers who had undergone uterus transplantation (one mother had two pregnancies and delivered two babies). All pregnancies were singleton. The mothers received immunosuppressive therapy, and one had a rejection episode that was detected during pregnancy. The rejection episode resolved after steroid treatment. The infants had a median gestational age of 366/7 weeks (range: 306/7-380/7 weeks) and median birth weight of 2,920 g (range: 1,770-3,470 g). The lowest Apgar's score at 5 minutes was 8. All infants were appropriate size for gestational age. Two infants presented with bandemia but negative blood cultures. At 2 months of age, all infants achieved the developmental and behavioral milestones outlined by the American Academy of Pediatrics. CONCLUSION The 12 infants born from mothers with uterus transplants had a neonatal course that reflected the gestational age at delivery. No baby was born with an identified malformation or organ dysfunction. Longer follow-up and a larger number of infants are needed to confirm these observations. KEY POINTS · Normal fetal development after uterus transplantation.. · No baby was born with malformations or showed any organ dysfunction.. · At 2 months, all infants achieved appropriate developmental and behavioral milestones..
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Affiliation(s)
- Jackie R York
- Department of Neonatology, Baylor University Medical Center, Dallas, Texas
| | - Giuliano Testa
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | - Robert T Gunby
- Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, Texas
| | - J Michael Putman
- Fertility Center of Dallas, Baylor University Medical Center, Dallas, Texas
| | - Gregory J McKenna
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | - Eric C Koon
- Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, Texas
| | - Johanna Bayer
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | - Lilly Zhang
- Fertility Center of Dallas, Baylor University Medical Center, Dallas, Texas
| | - Anthony R Gregg
- Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, Texas.,Department of Obstetrics and Gynecology, PRISMA Health-University of South Carolina School of Medicine, Columbia, South Carolina
| | - Liza Johannesson
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas.,Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, Texas
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Amsalu R, Oltman SP, Medvedev MM, Baer RJ, Rogers EE, Shiboski SC, Jelliffe-Pawlowski L. Predicting the risk of 7-day readmission in late preterm infants in California: A population-based cohort study. Health Sci Rep 2023; 6:e994. [PMID: 36605457 PMCID: PMC9808150 DOI: 10.1002/hsr2.994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/10/2022] [Accepted: 12/07/2022] [Indexed: 01/04/2023] Open
Abstract
Background and aims The American Academy of Pediatrics describes late preterm infants, born at 34 to 36 completed weeks' gestation, as at-risk for rehospitalization and severe morbidity as compared to term infants. While there are prediction models that focus on specific morbidities, there is limited research on risk prediction for early readmission in late preterm infants. The aim of this study is to derive and validate a model to predict 7-day readmission. Methods This is a population-based retrospective cohort study of liveborn infants in California between January 2007 to December 2011. Birth certificates, maintained by California Vital Statistics, were linked to a hospital discharge, emergency department, and ambulatory surgery records maintained by the California Office of Statewide Health Planning and Development. Random forest and logistic regression were used to identify maternal and infant variables of importance, test for association, and develop and validate a predictive model. The predictive model was evaluated for discrimination and calibration. Results We restricted the sample to healthy late preterm infants (n = 122,014), of which 4.1% were readmitted to hospital within 7-day after birth discharge. The random forest model with 24 variables had better predictive ability than the 8 variable logistic model with c-statistic of 0.644 (95% confidence interval 0.629, 0.659) in the validation data set and Brier score of 0.0408. The eight predictors of importance length of stay, delivery method, parity, gestational age, birthweight, race/ethnicity, phototherapy at birth hospitalization, and pre-existing or gestational diabetes were used to drive individual risk scores. The risk stratification had the ability to identify an estimated 19% of infants at greatest risk of readmission. Conclusions Our 7-day readmission predictive model had moderate performance in differentiating at risk late preterm infants. Future studies might benefit from inclusion of more variables and focus on hospital practices that minimize risk.
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Affiliation(s)
- Ribka Amsalu
- California Preterm Birth Initiative University of California San Francisco San Francisco California USA
| | - Scott P Oltman
- California Preterm Birth Initiative University of California San Francisco San Francisco California USA.,Department of Epidemiology & Biostatistics University of California San Francisco San Francisco California USA
| | - Melissa M Medvedev
- Department of Pediatrics University of California San Francisco San Francisco California USA.,London School of Hygiene & Tropical Medicine, Maternal, Adolescent, Reproductive and Child Health Centre London UK
| | - Rebecca J Baer
- California Preterm Birth Initiative University of California San Francisco San Francisco California USA.,Department of Pediatrics University of California San Diego La Jolla California USA
| | - Elizabeth E Rogers
- Department of Pediatrics University of California San Francisco San Francisco California USA
| | - Stephen C Shiboski
- Department of Epidemiology & Biostatistics University of California San Francisco San Francisco California USA
| | - Laura Jelliffe-Pawlowski
- California Preterm Birth Initiative University of California San Francisco San Francisco California USA.,Department of Epidemiology & Biostatistics University of California San Francisco San Francisco California USA
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Hwang YS, Chen CC, Shih HN, Tsai WH. Higher risk for poor handwriting in Taiwanese children born late preterm. Pediatr Neonatol 2022; 64:306-312. [PMID: 36464586 DOI: 10.1016/j.pedneo.2022.06.017] [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: 02/11/2022] [Revised: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Late-preterm and early-term births constitute a significant proportion of live births. However, handwriting skills of these two populations remain unclear. We aimed to investigate their risk for poor Chinese handwriting in grade two. METHODS In this observational study, 185 second graders born late preterm (34+0-36+6 weeks' gestation, n = 54), early term (37+0-38+6 weeks' gestation, n = 56), and full term (39+0-41+6 weeks' gestation, n = 75) without any intervention or diagnosis related to developmental delays were included. Their handwriting performance was rated by class teachers using the Chinese Handwriting Evaluation Form (CHEF), which is a standardized handwriting scale including five handwriting dimensions (construction, accuracy, directionality, speed, and pencil grasp). RESULTS After controlling for demographic risk factors, the late-preterm born group had a greater risk of having worse performance in the full form (adjusted odds ratio [aOR] = 3.93; p = .038) and construction dimension (aOR = 4.77; p = .009) of the CHEF than peers born at full term, whereas the risks were comparable for the early- and full-term born groups (aOR = 0.14-1.90; p = .073-0.453 in the handwriting dimensions). CONCLUSIONS Late-preterm but not early-term born children were found to be at higher risk for poor Chinese handwriting in grade two. They particularly have difficulty with spatial construction including size, spacing, and alignment of Chinese characters and components that may influence handwriting legibility.
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Affiliation(s)
- Yea-Shwu Hwang
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, 1 University Road, East District, Tainan City, 701401, Taiwan
| | - Chih-Cheng Chen
- Section of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital Kaohsiung Branch and Chang Gung University, College of Medicine, 123 Dapi Road, Kaohsiung City, Niaosong District, 833401, Taiwan
| | - Hui-Ning Shih
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, 1 University Road, East District, Tainan City, 701401, Taiwan
| | - Wen-Hui Tsai
- Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, 1 Changda Road, Gueiren District, Tainan City, 711301, Taiwan; Division of Neonatology, Department of Pediatrics, Chi Mei Medical Center, 901 Zhonghua Rd., Yongkang District, Tainan City, 71004, Taiwan.
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35
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Mally P, Katz J, Verma S, Purrier S, Wachtel EV, Trillo R, Bhutada K, Bailey SM. Impact on neonatal morbidities after a change in policy to administer antenatal corticosteroids to mothers at risk for late preterm delivery. J Perinat Med 2022; 51:573-579. [PMID: 36318716 DOI: 10.1515/jpm-2022-0113] [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: 03/24/2022] [Accepted: 09/11/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Antenatal corticosteroids (ACS) administered to mothers at risk for preterm delivery before 34 weeks has been standard care to improve neonatal outcomes. After introducing a new obstetric policy based on updated recommendations advising the administration of ACS to pregnant women at risk for late preterm (LPT) delivery (34-36 6/7 weeks), we set out to determine the short-term clinical impact on those LPT neonates. METHODS Retrospective chart review of LPT neonates delivered at NYU Langone Medical Center both one year before and after the policy went into place. We excluded subjects born to mothers with pre-gestational diabetes, multiple gestations, and those with congenital/genetic abnormalities. We also excluded subjects whose mothers already received ACS previously in pregnancy. Subjects were divided into pre-policy and post-policy groups. Neonatal and maternal data were compared for both groups. RESULTS 388 subjects; 180 in the pre-policy and 208 in the post-policy group. This policy change resulted in a significant increase in ACS administration to mothers who delivered LPT neonates (67.3 vs. 20.6%, p<0.001). In turn, there was a significant reduction in LPT neonatal intensive care unit (NICU) admissions (44.2 vs. 54.4%, p=0.04) and need for respiratory support (27.9 vs. 42.8%, p<0.01). However, we also found an increased incidence of hypoglycemia (49.5 vs. 28.3%, p<0.001). CONCLUSIONS This LPT ACS policy appears effective in reducing the need for LPT NICU level care overall. However, clinicians must be attentive to monitor for adverse effects like hypoglycemia, and there remains a need for better understanding of potential long-term impacts.
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Affiliation(s)
- Pradeep Mally
- Division of Neonatology, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
| | - Julia Katz
- Zucker School of Medicine at Hofstra/Northwell, Uniondale, NY, USA
| | - Sourabh Verma
- Division of Neonatology, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
| | - Sheryl Purrier
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Elena V Wachtel
- Division of Neonatology, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
| | | | | | - Sean M Bailey
- Division of Neonatology, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
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Resende MHF, Yarnell CJ, D'Souza R, Lapinsky SE, Nam A, Shah V, Whittle W, Wright JK, Naimark DMJ. Clinical decision analysis of elective delivery vs expectant management for pregnant individuals with COVID-19-related acute respiratory distress syndrome. Am J Obstet Gynecol MFM 2022; 4:100697. [PMID: 35878805 PMCID: PMC9307282 DOI: 10.1016/j.ajogmf.2022.100697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pregnant individuals are vulnerable to COVID-19-related acute respiratory distress syndrome. There is a lack of high-quality evidence on whether elective delivery or expectant management leads to better maternal and neonatal outcomes. OBJECTIVE This study aimed to determine whether elective delivery or expectant management are associated with higher quality-adjusted life expectancy for pregnant individuals with COVID-19-related acute respiratory distress syndrome and their neonates. STUDY DESIGN We performed a clinical decision analysis using a patient-level model in which we simulatedpregnant individuals and their unborn children. We used a patient-level model with parallel open-cohort structure, daily cycle length, continuous discounting, lifetime horizon, sensitivity analyses for key parameter values, and 1000 iterations for quantification of uncertainty. We simulated pregnant individuals at 32 weeks of gestation, invasively ventilated because of COVID-19-related acute respiratory distress syndrome. In the elective delivery strategy, pregnant individuals received immediate cesarean delivery. In the expectant management strategy, pregnancies continued until spontaneous labor or obstetrical decision to deliver. For both pregnant individuals and neonates, model outputs were hospital or perinatal survival, life expectancy, and quality-adjusted life expectancy denominated in years, summarized by the mean and 95% credible interval. Maternal utilities incorporated neonatal outcomes in accordance with best practices in perinatal decision analysis. RESULTS Model outputs for pregnant individuals were similar when comparing elective delivery at 32 weeks' gestation with expectant management, including hospital survival (87.1% vs 87.4%), life-years (difference, -0.1; 95% credible interval, -1.4 to 1.1), and quality-adjusted life expectancy denominated in years (difference, -0.1; 95% credible interval, -1.3 to 1.1). For neonates, elective delivery at 32 weeks' gestation was estimated to lead to a higher perinatal survival (98.4% vs 93.2%; difference, 5.2%; 95% credible interval, 3.5-7), similar life-years (difference, 0.9; 95% credible interval, -0.9 to 2.8), and higher quality-adjusted life expectancy denominated in years (difference, 1.3; 95% credible interval, 0.4-2.2). For pregnant individuals, elective delivery was not superior to expectant management across a range of scenarios between 28 and 34 weeks of gestation. Elective delivery in cases where intrauterine death or maternal mortality were more likely resulted in higher neonatal quality-adjusted life expectancy, as did elective delivery at 30 weeks' gestation (difference, 1.1 years; 95% credible interval, 0.1 - 2.1) despite higher long-term complications (4.3% vs 0.5%; difference, 3.7%; 95% credible interval, 2.4-5.1), and in cases where intrauterine death or maternal acute respiratory distress syndrome mortality were more likely. CONCLUSION The decision to pursue elective delivery vs expectant management in pregnant individuals with COVID-19-related acute respiratory distress syndrome should be guided by gestational age, risk of intrauterine death, and maternal acute respiratory distress syndrome severity. For the pregnant individual, elective delivery is comparable but not superior to expectant management for gestational ages from 28 to 34 weeks. For neonates, elective delivery was superior if gestational age was ≥30 weeks and if the rate of intrauterine death or maternal mortality risk were high. We recommend basing the decision for elective delivery vs expectant management in a pregnant individual with COVID-19-related acute respiratory distress syndrome on gestational age and likelihood of intrauterine or maternal death.
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Affiliation(s)
- Maura H Ferrari Resende
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (Drs Ferrari Resende, Yarnell, Shah, and Naimark); Sunnybrook Health Sciences Centre, Toronto, Canada (Drs Ferrari Resende and Naimark)
| | - Christopher J Yarnell
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (Drs Ferrari Resende, Yarnell, Shah, and Naimark); Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada (Dr Yarnell and Dr Lapinsky); Department of Critical Care Medicine, Sinai Health System and the University Health Network, Toronto, Canada (Dr Yarnell and Dr Lapinsky).
| | - Rohan D'Souza
- Departments of Obstetrics and Gynecology and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada (Dr D'Souza); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sinai Health System, University of Toronto, Toronto, Canada (Drs D'Souza and Whittle)
| | - Stephen E Lapinsky
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada (Dr Yarnell and Dr Lapinsky); Department of Critical Care Medicine, Sinai Health System and the University Health Network, Toronto, Canada (Dr Yarnell and Dr Lapinsky); Department of Medicine, University of Toronto, Toronto, Canada (Dr Lapinsky and Drs Wright and Naimark)
| | | | - Vibhuti Shah
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (Drs Ferrari Resende, Yarnell, Shah, and Naimark); Department of Pediatrics, Mount Sinai Hospital, Toronto, Canada (Dr Shah)
| | - Wendy Whittle
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sinai Health System, University of Toronto, Toronto, Canada (Drs D'Souza and Whittle)
| | - Julie K Wright
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada (Dr Wright); Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada (Dr Wright); Department of Medicine, University of Toronto, Toronto, Canada (Dr Lapinsky and Drs Wright and Naimark)
| | - David M J Naimark
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (Drs Ferrari Resende, Yarnell, Shah, and Naimark); Sunnybrook Health Sciences Centre, Toronto, Canada (Drs Ferrari Resende and Naimark); Department of Medicine, University of Toronto, Toronto, Canada (Dr Lapinsky and Drs Wright and Naimark)
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Nelson HD, Darney BG, Ahrens K, Burgess A, Jungbauer RM, Cantor A, Atchison C, Eden KB, Goueth R, Fu R. Associations of Unintended Pregnancy With Maternal and Infant Health Outcomes: A Systematic Review and Meta-analysis. JAMA 2022; 328:1714-1729. [PMID: 36318133 PMCID: PMC9627416 DOI: 10.1001/jama.2022.19097] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
IMPORTANCE Unintended pregnancy is common in the US and is associated with adverse maternal and infant health outcomes; however, estimates of these associations specific to current US populations are lacking. OBJECTIVE To evaluate associations of unintended pregnancy with maternal and infant health outcomes during pregnancy and post partum with studies relevant to current clinical practice and public health in the US. DATA SOURCES Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, PsycINFO, SocINDEX, and MEDLINE databases (January 1, 2000, to June 15, 2022) and manual review of reference lists. STUDY SELECTION Epidemiologic studies relevant to US populations that compared key maternal and infant health outcomes for unintended vs intended pregnancies and met prespecified eligibility criteria were included after investigators' independent dual review of abstracts and full-text articles. DATA EXTRACTION AND SYNTHESIS Investigators abstracted data from publications on study methods, participant characteristics, settings, pregnancy intention, comparators, confounders, and outcomes; data were validated by a second investigator. Risk of bias was independently dual rated by investigators using criteria developed by the US Preventive Services Task Force. Results of studies controlling for confounders were combined by using a profile likelihood random-effects model. MAIN OUTCOMES AND MEASURES Prenatal depression, postpartum depression, maternal experience of interpersonal violence, preterm birth, and infant low birth weight. RESULTS Thirty-six studies (N = 524 522 participants) were included (14 cohort studies rated good or fair quality; 22 cross-sectional studies); 12 studies used large population-based data sources. Compared with intended pregnancy, unintended pregnancy was significantly associated with higher odds of depression during pregnancy (23.3% vs 13.9%; adjusted odds ratio [aOR], 1.59 [95% CI, 1.35-1.92]; I2 = 85.0%; 15 studies [n = 41 054]) and post partum (15.7% vs 9.6%; aOR, 1.51 [95% CI, 1.40-1.70]; I2 = 7.1%; 10 studies [n = 82 673]), interpersonal violence (14.6% vs 5.5%; aOR, 2.22 [95% CI, 1.41-2.91]; I2 = 64.1%; 5 studies [n = 42 306]), preterm birth (9.4% vs 7.7%; aOR, 1.21 [95% CI, 1.12-1.31]; I2 = 1.7%; 10 studies [n = 94 351]), and infant low birth weight (7.3% vs 5.2%; aOR, 1.09 [95% CI, 1.02-1.21]; I2 = 0.0%; 8 studies [n = 87 547]). Results were similar in sensitivity analyses based on controlling for history of depression for prenatal and postpartum depression and on study design and definition of unintended pregnancy for relevant outcomes. Studies provided limited sociodemographic data and measurement of confounders and outcomes varied. CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis of epidemiologic observational studies relevant to US populations, unintended pregnancy, compared with intended pregnancy, was significantly associated with adverse maternal and infant outcomes. TRIAL REGISTRATION PROSPERO Identifier: CRD42020192981.
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Affiliation(s)
- Heidi D. Nelson
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Blair G. Darney
- Oregon Health & Science University, Portland
- Oregon Health & Science University/Portland State University School of Public Health, Portland
- Instituto Nacional de Salud Pública, Centro de Investigación en Salud Poblacional, Cuernavaca, México
| | - Katherine Ahrens
- Public Health Program of the Muskie School of Public Service, University of Southern Maine, Portland
| | - Amanda Burgess
- Public Health Program of the Muskie School of Public Service, University of Southern Maine, Portland
| | - Rebecca M. Jungbauer
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Amy Cantor
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Chandler Atchison
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Karen B. Eden
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Rose Goueth
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Rongwei Fu
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
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Measuring quality of care in moderate and late preterm infants. J Perinatol 2022; 42:1294-1300. [PMID: 35354940 PMCID: PMC9522891 DOI: 10.1038/s41372-022-01377-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/22/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine quality measures for moderate and late preterm (MLP) infants. STUDY DESIGN By prospectively analyzing Vermont Oxford Network's all NICU admissions database, we adapted Baby-MONITOR, a composite quality measure for extremely/very preterm infants, for MLP infants. We examined correlations between the adapted MLP quality measure (MLP-QM) in MLP infants and Baby-MONITOR in extremely and very preterm infants. RESULT We studied 376,219 MLP (30-36 weeks GA) and 57,595 extremely/very preterm (25-29 weeks GA) infants from 465 U.S. hospitals born from 2016 to 2020. MLP-QM summary scores in MLP infants had weak correlation with Baby-MONITOR scores in extremely and very preterm infants (r = 0.47). There was weak correlation among survival (r = 0.19), no pneumothorax (r = 0.35), and no infection after 3 days (r = 0.45), but strong correlation among human milk at discharge (r = 0.79) and no hypothermia (r = 0.76). CONCLUSION Modest correlation among hospital care measures in two preterm populations suggests the need for MLP-specific care measures.
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Fayed A, Wahabi HA, Esmaeil S, Elmorshedy H, AlAniezy H. Preterm, early term, and post-term infants from Riyadh mother and baby multicenter cohort study: The cohort profile. Front Public Health 2022; 10:928037. [PMID: 36187618 PMCID: PMC9516634 DOI: 10.3389/fpubh.2022.928037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/09/2022] [Indexed: 01/24/2023] Open
Abstract
Background Birth before 37 or beyond 42 gestational weeks is associated with adverse neonatal and maternal outcomes. Studies investigating determinants and outcomes of these deliveries are scarce. The objective of this study was to determine the neonatal birth profile in relation to the gestational age at delivery and to evaluate its influence on the immediate maternal and neonatal outcomes. Methods This is a multicenter cohort study of 13,403 women conducted in three hospitals in Riyadh. Collected data included sociodemographic characteristics, obstetric history, and physical and laboratory measurements. Regression models were developed to estimate the adjusted odds ratio (OR) and confidence intervals (CI) to determine factors associated with preterm, early term, and post-term births and to evaluate common maternal and neonatal risks imposed by deliveries outside the full term. Results The incidence of preterm, early term, and post-term delivery was 8.4%, 29.8%, and 1.4%, respectively. Hypertensive events during pregnancy consistently increased the risk of all grades of preterm births, from more than 3-fold for late preterm (OR = 3.40, 95% CI = 2.21-5.23) to nearly 7-fold for extremely early preterm (OR = 7.11, 95% CI = 2.24-22.60). Early term was more likely to occur in older mothers (OR = 1.30, 95% CI = 1.13-1.49), grand multiparous (OR = 1.21, 95% CI = 1.06-1.38), pregestational diabetes (OR = 1.91, 95% CI = 1.49-2.44), and gestational diabetes women (OR = 1.18, 95% CI = 1.05-1.33). The risk of post-term birth was higher in primiparous. In preterm births, the adverse outcome of neonates having an APGAR score of <7 at 5 min and admission to neonatal intensive care units increased progressively as the gestational age decreased. Post-term births are 2-fold more likely to need induction of labor; meanwhile, preterm births were more likely to deliver by cesarean section. Conclusion This large cohort study was the first in Saudi Arabia to assess the delivery profile across a continuum of gestational age and the associated maternal and neonatal adverse outcomes of deliveries outside the full-term period. The study showed that the prevalence of preterm and post-term birth in Saudi Arabia is similar to the prevalence in other high-income countries. The immediate adverse pregnancy outcomes inversely increased with the decrease in gestational age at delivery. In addition, maternal age, hypertension, diabetes, and parity influenced the gestational age at delivery.
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Affiliation(s)
- Amel Fayed
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Hayfaa A. Wahabi
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia,Department of Family and Community Medicine, King Saud University Medical City and College of Medicine, Riyadh, Saudi Arabia
| | - Samia Esmaeil
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia,*Correspondence: Samia Esmaeil
| | - Hala Elmorshedy
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Hilala AlAniezy
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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40
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Amsalu R, Oltman SP, Baer RJ, Medvedev MM, Rogers EE, Jelliffe-Pawlowski L. Incidence, Risk Factors, and Reasons for 30-Day Hospital Readmission Among Healthy Late Preterm Infants. Hosp Pediatr 2022; 12:639-649. [PMID: 35694876 PMCID: PMC9997672 DOI: 10.1542/hpeds.2021-006215] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Late preterm infants have an increased risk of morbidity relative to term infants. We sought to determine the rate, temporal trend, risk factors, and reasons for 30-day readmission. METHODS This is a retrospective cohort study of infants born at 34 to 42 weeks' gestation in California between January 1, 2011, and December 31, 2017. Birth certificates maintained by California Vital Statistics were linked to discharge records maintained by the California Office of Statewide Health Planning and Development. Multivariable logistic regression was used to identify risk factors and derive a predictive model. RESULTS Late preterm infants represented 4.3% (n = 122 014) of the study cohort (n = 2 824 963), of which 5.9% (n = 7243) were readmitted within 30 days. Compared to term infants, late preterm infants had greater odds of readmission (odds ratio [OR]: 2.34 [95% confidence interval (CI): 2.28-2.40]). The temporal trend indicated increases in all-cause and jaundice-specific readmission infants (P < .001). The common diagnoses at readmission were jaundice (58.9%), infections (10.8%), and respiratory complications (3.5%). In the adjusted model, factors that were associated with greater odds of readmission included assisted vaginal birth, maternal age ≥34 years, diabetes, chorioamnionitis, and primiparity. The model had predictive ability of 60% (c-statistic 0.603 [95% CI: 0.596-0.610]) in late preterm infants who had <5 days length of stay at birth. CONCLUSION The findings contribute important information on what factors increase or decrease the risk of readmission. Longitudinal studies are needed to examine promising hospital predischarge and follow-up care practices.
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Affiliation(s)
| | - Scott P Oltman
- California Preterm Birth Initiative
- Departments of Epidemiology & Biostatistics
| | - Rebecca J Baer
- California Preterm Birth Initiative
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Melissa M Medvedev
- Pediatrics, University of California San Francisco, San Francisco, California
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Elizabeth E Rogers
- Pediatrics, University of California San Francisco, San Francisco, California
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Cho GJ, Cho KD, Kim HY, Ha S, Oh MJ, Won HS, Chung JH. Short-term neonatal and long-term infant outcome of late-preterm twins: nationwide population-based study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:763-770. [PMID: 34931725 DOI: 10.1002/uog.24838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 11/04/2021] [Accepted: 12/02/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To evaluate the short- and long-term outcome of late-preterm compared with term birth in twin pregnancy. METHODS This retrospective observational cohort study included all women who had a twin delivery between 1 January 2007 and 31 December 2010 recorded in the claims database of the Korea National Health Insurance, with at least one follow-up recorded in the database of the National Health Screening Program for Infants and Children. Outcomes were analyzed at the pregnancy level, with adverse outcome being defined as an adverse outcome in one or both twins, identified by a diagnosis according to the International Classification of Diseases 10th Revision. The primary short-term outcome was composite morbidity, which included any of the following: transient tachypnea, respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage and bronchopulmonary dysplasia. Long-term adverse outcome included any neurological or neurodevelopmental outcome, defined by prespecified neurological and developmental diagnoses; these were assessed by following up all neonates until the end of 2018, by which time they were 8-11 years of age. Outcomes were compared between twins delivered late preterm (34 + 0 to 36 + 6 weeks) and those delivered at term (≥ 37 weeks). RESULTS Among 17 189 women who delivered twins at ≥ 34 weeks of gestation during the study period, 5032 (29.27%) women delivered in the late-preterm period. On multivariate analysis, compared with the twins delivered at term, the late-preterm twins had an increased risk for the primary short-term outcome of composite morbidity (adjusted odds ratio (aOR), 2.09; 95% CI, 1.90-2.30), including transient tachypnea (aOR, 1.85; 95% CI, 1.64-2.09), respiratory distress syndrome (aOR, 2.31; 95% CI, 2.04-2.62), necrotizing enterocolitis (aOR, 2.10; 95% CI, 1.20-3.69) and intraventricular hemorrhage (aOR, 2.13; 95% CI, 1.46-3.11). For the long-term outcome, the late-preterm twins also had an increased risk for any neurological or neurodevelopmental outcome (adjusted hazard ratio, 1.14; 95% CI, 1.07-1.21). CONCLUSIONS Twins delivered in the late-preterm period have an increased risk for short- and long-term morbidity compared with twins delivered at term. These results should be considered when determining the timing of delivery in uncomplicated twin pregnancy. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- G J Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - K-D Cho
- Big Data Department, National Health Insurance Service, Gangwon-do, Korea
| | - H Y Kim
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - S Ha
- Graduate School of Statistics, Sungkyunkwan University, Seoul, Korea
| | - M-J Oh
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - H-S Won
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - J H Chung
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Chen Z, Xiong C, Liu H, Duan J, Kang C, Yao C, Chen K, Chen Y, Liu Y, Liu M, Zhou A. Impact of early term and late preterm birth on infants' neurodevelopment: evidence from a cohort study in Wuhan, China. BMC Pediatr 2022; 22:251. [PMID: 35513822 PMCID: PMC9074243 DOI: 10.1186/s12887-022-03312-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background The incidences of early term and late preterm birth have increased worldwide during recent years. However, there is a lack of prospective study about the influence of early term and late preterm birth on infants’ neurodevelopment, especially at the early stage. Therefore, we conducted this cohort study to investigate the impact of early term and late preterm birth on infants’ neurodevelopment within 6 months. Methods This cohort study was conducted in Wuhan, China, between October 2012 and September 2013. A total of 4243 singleton infants born within 34-41 weeks of gestation at Wuhan Children’s Hospital were included. The Gesell Developmental Scale (GDS) was utilized to evaluate the neurodevelopment of infants. Results Among the 4243 included participants, 155 (3.65%) were late preterm infants, 1288 (30.36%) were early term infants, and 2800 (65.99%) were full term infants. After adjusted for potential confounders, significant negative relationship was shown between late preterm birth and development quotient (DQ) in all domains of neurodevelopment: gross motor (β = − 17.42, 95% CI: − 21.15 to − 13.69), fine motor (β = − 23.61, 95% CI: − 28.52 to − 18.69), adaptability (β = − 10.10, 95% CI: − 13.82 to − 6.38), language (β = − 6.28, 95% CI: − 9.82 to − 2.74) and social behavior (β = − 5.99, 95% CI: − 9.59 to − 2.39). There was a significant negative trend for early term birth in DQ of fine motor (β = − 2.01, 95% CI: − 3.93 to − 0.09). Late preterm infants had a significantly elevated risk of neurodevelopmental delay in domains of gross motor (adjusted OR = 3.82, 95% CI: 2.67 to 5.46), fine motor (adjusted OR = 3.51, 95% CI: 2.47 to 5.01), and adaptability (adjusted OR = 1.60, 95% CI: 1.12 to 2.29), whereas early term birth was significantly associated with neurodevelopmental delay of fine motor (adjusted OR = 1.22, 95% CI: 1.05 to 1.42). Conclusions This study suggested that late preterm birth mainly elevated the risk of neurodevelopmental delay of gross motor, fine motor, and adaptability, whereas early term birth was associated with the developmental delay of fine motor within 6 months. Further research is needed to determine the effectiveness and necessity of the interventions at the early stage for early term and late preterm infants who had suspected neurodevelopmental delay.
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Affiliation(s)
- Zhong Chen
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No.100, Hong Kong Road, Jiang'an District, Wuhan, 430016, China.
| | - Chao Xiong
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No.100, Hong Kong Road, Jiang'an District, Wuhan, 430016, China
| | - Hua Liu
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No.100, Hong Kong Road, Jiang'an District, Wuhan, 430016, China
| | - Junyu Duan
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No.100, Hong Kong Road, Jiang'an District, Wuhan, 430016, China
| | - Chun Kang
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No.100, Hong Kong Road, Jiang'an District, Wuhan, 430016, China
| | - Cong Yao
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No.100, Hong Kong Road, Jiang'an District, Wuhan, 430016, China
| | - Kai Chen
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No.100, Hong Kong Road, Jiang'an District, Wuhan, 430016, China
| | - Yawen Chen
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No.100, Hong Kong Road, Jiang'an District, Wuhan, 430016, China
| | - Yan Liu
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No.100, Hong Kong Road, Jiang'an District, Wuhan, 430016, China
| | - Mingzhu Liu
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No.100, Hong Kong Road, Jiang'an District, Wuhan, 430016, China
| | - Aifen Zhou
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No.100, Hong Kong Road, Jiang'an District, Wuhan, 430016, China.
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Yoshida-Montezuma Y, Sivapathasundaram B, Brown HK, Keown-Stoneman C, de Souza RJ, To T, Borkhoff CM, Birken CS, Maguire JL, Anderson LN. Association of Late Preterm Birth and Size for Gestational Age With Cardiometabolic Risk in Childhood. JAMA Netw Open 2022; 5:e2214379. [PMID: 35622362 PMCID: PMC9142868 DOI: 10.1001/jamanetworkopen.2022.14379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE The long-term cardiometabolic consequences of late preterm birth (34-36 weeks' gestation) are not well understood. OBJECTIVE To assess whether late preterm birth and size for gestational age are associated with cardiometabolic risk (CMR) in childhood. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included 1742 children born in Ontario, Canada, between April 1, 2006, and September 30, 2014, and followed up until September 30, 2019. Data from children enrolled in The Applied Research Group for Kids (TARGet Kids!) primary care practice-based research network were linked to administrative health care data at ICES (formerly known as the Institute for Clinical Evaluative Sciences). Participants were excluded if they had conditions affecting growth (eg, failure to thrive or cystic fibrosis), any acute or chronic conditions (other than asthma and high-functioning autism), severe developmental delay, or families who were unable to communicate in English. EXPOSURES Late preterm birth, gestational age as a continuous measure, and size for gestational age. MAIN OUTCOMES AND MEASURES The primary outcome was composite CMR score (overall age- and sex-standardized z score of CMR components, including waist circumference, log triglyceride level, glucose level, systolic blood pressure, and high-density lipoprotein cholesterol level). Secondary outcomes were the individual CMR components. Multivariable linear regression analysis was used to separately evaluate the associations of late preterm birth, continuous gestational age, and size for gestational age with CMR at ages 3 to 12 years. RESULTS Among 2440 eligible children, 1742 (mean [SD] age, 5.6 [2.2] years; 951 boys [54.6%]) were included in the final cohort. Overall, 87 children (5.0%) were born moderately preterm (<34 weeks' gestation), 145 (8.3%) were born late preterm (34-36 weeks' gestation), 455 (26.1%) were born early term (37-38 weeks' gestation), and 1055 (60.6%) were born full term (≥39 weeks' gestation). Compared with children born full term, those born moderately preterm (adjusted β = 0.50; 95% CI, 0.24-0.75) and late preterm (adjusted β = 0.27; 95% CI, 0.06-0.47) had higher CMR scores. Each additional gestational week was associated with a 0.06 U (adjusted β; 95% CI, -0.08 to -0.03 U) decrease in CMR. CONCLUSIONS AND RELEVANCE In this study, children born late preterm and moderately preterm had higher CMR. These results suggest that screening and early-life interventions for these children may prevent cardiometabolic outcomes.
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Affiliation(s)
- Yulika Yoshida-Montezuma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Branavan Sivapathasundaram
- ICES (formerly the Institute for Clinical Evaluative Sciences), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Hilary K. Brown
- ICES (formerly the Institute for Clinical Evaluative Sciences), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- Women’s College Research Institute, Toronto, Ontario, Canada
| | - Charles Keown-Stoneman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Russell J. de Souza
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Teresa To
- ICES (formerly the Institute for Clinical Evaluative Sciences), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Cornelia M. Borkhoff
- Women’s College Research Institute, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Catherine S. Birken
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon L. Maguire
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Laura N. Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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García H, Loureiro C, Poggi H, D'Apremont I, Moore R, Ossa JT, Bruera MJ, Peredo S, Carvajal J, Trincado C, Martínez‐Aguayo A. Insulin resistance parameters in children born very preterm and adequate for gestational age. Endocrinol Diabetes Metab 2022; 5:e00329. [PMID: 35194980 PMCID: PMC9094455 DOI: 10.1002/edm2.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Preterm neonates are at risk for metabolic syndrome later in life. Whether prematurity constitutes an independent risk factor for the development of cardiovascular disease and metabolic syndrome remains controversial. OBJECTIVE To compare anthropometric measures, cardiometabolic risk factors and insulin resistance variables between children who were born very preterm (VPT, <32 gestational weeks) and at term (Term, >37 gestational weeks) and adequate for gestational age (AGA). METHODS We designed a cross-sectional cohort study, recruiting 120 children (5.0-8.5 years old) from the preterm clinic at Red de Salud UC-Christus and Complejo Asistencial Dr. Sótero del Río, and term children from the community. We excluded children born small for gestational age, based on INTERGROWTH21. Anthropometrics data were classified using WHO reference standards. The homeostasis model assessment insulin resistance (HOMA-IR) index, quantitative insulin sensitivity check index (QUICKI), triglyceride-to-HDL-C ratio (TG/HDL-C) and Pediatric Score Index for Metabolic Syndrome (PsiMS) were calculated. RESULTS VPT children born AGA had lower HDL cholesterol levels (p = .019) and a higher PsiMS score than those born at term (p = .043). We observed a higher percentage of children with HDL cholesterol ≤40 mg/dl (13.0% vs. 2.3%, p = .026) and BP ≥90th percentile among the VPT children than among the Term children (26.0% vs. 11.6%, p = .031). CONCLUSIONS At school age, blood pressure was higher, and HDL-C was lower among VPT children born AGA, suggesting a potential metabolic risk; therefore, it is essential to follow this group throughout their lives.
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Affiliation(s)
- Hernán García
- Pediatric DivisionSchool of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Carolina Loureiro
- Pediatric DivisionSchool of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Helena Poggi
- Pediatric DivisionSchool of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Ivonne D'Apremont
- Pediatric DivisionSchool of MedicinePontificia Universidad Católica de ChileSantiagoChile
- Complejo Asistencial Dr. Sótero del RíoPuente Alto, SantiagoChile
| | - Rosario Moore
- Pediatric DivisionSchool of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - José Tomás Ossa
- School of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - María José Bruera
- School of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Soledad Peredo
- Pediatric DivisionSchool of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | | | - Claudia Trincado
- Pediatric DivisionSchool of MedicinePontificia Universidad Católica de ChileSantiagoChile
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Dani C, Ciarcià M, Miselli F, Luzzati M, Coviello C, Azzarelli F, Ferrara M, Lori I, Pezzati M. The management of late preterm infants: effects of rooming-in assistance versus direct admission to neonatal care units. Eur J Pediatr 2022; 181:1643-1649. [PMID: 34993626 DOI: 10.1007/s00431-021-04337-z] [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: 09/06/2021] [Revised: 11/08/2021] [Accepted: 11/30/2021] [Indexed: 11/28/2022]
Abstract
Late preterm infants (LPIs) represent a significant percentage of all neonates (6-8%), but there are limited published data on their postnatal management. Our aim was to compare the frequency of neonatal intensive care unit (NICU) admission and the breastfeeding rate of LPIs born at 35+0-36+6 weeks of gestation who were cared for by initial rooming in strategy rather than directly admitted to the special care unit (SCU) and, eventually, to the NICU. We carried out a retrospective study in the perinatal centers of Careggi University Hospital (CUH) and San Giovanni di Dio Hospital in Florence, Italy, where the first and second strategies were applied, respectively. Main outcomes were LPIs admission rate at SCU/NICU and breastfeeding rate at discharge. We studied 190 LPIs born at SGDH and 240 born at CUH. The admission rate in SCU (81 vs. 43%; P < 0.001) and NICU (20 vs. 10%; P = 0.008) was higher in SGDH than in CUH, as was the exclusive breastfeeding rate (36 vs. 22%; P < 0.001). However, infants who were assisted in rooming-in at CUH and infants with similar clinical characteristics at SGDH had similar mixed (60 vs. 69%) and exclusive (35 vs. 31%) breastfeeding rates. Conclusion: Postnatal assistance of LPIs in rooming-in, eventually followed by admission in SCU/NICU based on their clinical conditions, allowed to safely halve their hospitalization. The assistance of infants in rooming-in did not negatively affect their breastfeeding rate. These results support the possibility of assisting LPIs in rooming-in. What is Known: • Late preterm infants represent a significant percentage of all neonates. • Early rooming-in and breastfeeding is recommended for late preterm infants. What is New: • Postnatal assistance of late preterm infants in rooming-in, followed when necessary by admission in neonatal units based on clinical conditions, allowed to safely avoid about half the number of hospitalizations in comparison with direct admission in neonatal units. • This strategy did not affect breastfeeding rate. Infants who were admitted to SCU/NICU after initial rooming-in had worst breastfeeding rate.
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Affiliation(s)
- Carlo Dani
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy. .,Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, Florence, 50141, Italy.
| | - Martina Ciarcià
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, Florence, 50141, Italy
| | - Francesca Miselli
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, Florence, 50141, Italy
| | - Michele Luzzati
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, Florence, 50141, Italy
| | - Caterina Coviello
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, Florence, 50141, Italy
| | | | - Marianna Ferrara
- Neonatal Intensive Care Unit, San Giovanni Di Dio Hospital, Florence, Italy
| | - Ilaria Lori
- Neonatal Intensive Care Unit, San Giovanni Di Dio Hospital, Florence, Italy
| | - Marco Pezzati
- Neonatal Intensive Care Unit, San Giovanni Di Dio Hospital, Florence, Italy
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McLaren R, Clark M, Narayanamoorthy S, Rastogi S. Antenatal factors for neonatal seizures among late preterm births. J Matern Fetal Neonatal Med 2022; 35:9544-9548. [PMID: 35253602 DOI: 10.1080/14767058.2022.2047924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate for antenatal risk factors for neonatal seizures among late preterm births. STUDY DESIGN This was a case control study which included late preterm births without anomaly from the United States Natality database. Cases were infants with neonatal seizures, while the controls consisted of infants without neonatal seizures. Maternal and pregnancy characteristics were compared. Multivariable logistic regression was performed to investigate risk factors for neonatal seizures. RESULTS Of the 943,580 late preterm births, 512 (0.05%) developed neonatal seizures. Significant risk factors associated with neonatal seizures among late preterm births included number of prenatal visits (adjusted odds ratio [aOR] 0.94, 95% CI [0.92-0.96]), smoking history (aOR 1.78, 95% CI [1.41-2.25]), chorioamnionitis (aOR 4.37, 95% CI [2.65-7.21]), non-Hispanic White race (aOR 1.41, 95% CI [1.13-1.76]), and cesarean birth (aOR 2.31, 95% CI [1.91-2.80]). CONCLUSION Number of prenatal visits, history of smoking, chorioamnionitis, non-Hispanic white race, and cesarean birth are risk factors for neonatal seizures at late preterm gestation.
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Affiliation(s)
- Rodney McLaren
- Division of Maternal-Fetal Medicine, Department of Obstetrics/Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Maureen Clark
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | | | - Shantanu Rastogi
- Children's National Hospital, School of Medicine and Health Sciences, Washington, DC, USA
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Syrengelas D, Nikaina E, Kleisiouni P, Siahanidou T. Alberta Infant Motor Scale (AIMS) Performance of Early-Term Greek Infants: The Impact of Shorter Gestation on Gross Motor Development among “Term-Born” Infants. CHILDREN 2022; 9:children9020270. [PMID: 35204990 PMCID: PMC8870654 DOI: 10.3390/children9020270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022]
Abstract
Early-term birth (37+0 to 38+6 gestational weeks) may have a negative impact on infants’ neurodevelopment compared to delivery at 39 weeks or beyond. The purpose of this study was to evaluate the gross motor development of early-term infants using the Alberta Infant Motor Scale (AIMS). A total of 1087 healthy infants (559 early-term and 528 full-term infants born at 39+0 to 41+6 weeks of gestation) were studied. Mean AIMS scores were compared between the two groups at monthly intervals. The impact of gestational age on total AIMS scores was assessed by linear regression, after adjustment for chronological age, sex and SGA. Mean total AIMS scores, albeit within normal range, were significantly lower in early-term than full-term infants at the 2nd, 6th, 7th, 8th and 12th month of age; differences between groups were within three points. In multivariate regression analysis, a longer gestation by one week had a positive impact on total AIMS score during the first year of life (β = 0.90; 95% CI 0.45, 1.35). In conclusion, early-term infants exhibit worse gross motor performance during the first year of life in comparison with their full-term peers; however, the differences between the two groups are small.
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Affiliation(s)
- Dimitris Syrengelas
- Department of Pediatric Physical Therapy, "Aghia Sophia" Children's Hospital, 11527 Athens, Greece
| | - Eirini Nikaina
- Neonatal Unit, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Paraskevi Kleisiouni
- Department of Pediatric Physical Therapy, "Aghia Sophia" Children's Hospital, 11527 Athens, Greece
| | - Tania Siahanidou
- Neonatal Unit, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Pal S, Sardar S, Sarkar N, Ghosh M, Chatterjee S. Effect of Antenatal Dexamethasone in Late Preterm Period on Neonatal Hypoglycemia: A Prospective Cohort Study from a Developing Country. J Trop Pediatr 2022; 68:6535685. [PMID: 35201359 DOI: 10.1093/tropej/fmac021] [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] [Indexed: 01/28/2023]
Abstract
OBJECTIVES This study compared the risk of hypoglycemia within 72 h of life in infants with and without exposure to antenatal dexamethasone in the late preterm period (34-366/7 week's gestational age). METHODS This prospective cohort study was conducted in a tertiary care neonatal unit of Eastern India from May 2021 to November 2021. Babies in the exposed group received at least one dose of antenatal dexamethasone in the late preterm period between 7 days before delivery and birth. 'Complete course' of antenatal steroid was defined as four doses of injection dexamethasone at 12 h intervals and <4 doses were considered as 'Partial course'. Primary outcome was incidence of hypoglycemia within 72 h of life, defined as whole blood glucose <45 mg/dl. RESULTS Total 298 infants (98 in control, 134 in partial and 66 in complete group) were assessed for final outcome. No significant difference in outcomes were seen in the exposed group compared to unexposed group. However, incidence of hypoglycemia within 72 h (complete vs. partial p= 0.008, complete vs. control p=0.005) and 12 h of life (complete vs. partial p=0.013, complete vs. control p=0.013) was significantly less in complete steroid group. Logistic regression analysis revealed complete course of antenatal corticosteroid significantly decreased the risk of hypoglycemia [adjusted odds ratio, 95% confidence interval (CI) 0.15 (0.03-0.69), p=0.015]. Number needed to be exposed for one additional benefit was 7 (95% CI, 6.35-22.14). CONCLUSION Complete course of dexamethasone administered to mothers at risk of late preterm delivery reduces risk of neonatal hypoglycemia within 72 h of life.
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Affiliation(s)
- Somnath Pal
- Department of Neonatology, IPGME&R, Kolkata 700020, India
| | - Syamal Sardar
- Department of Neonatology, IPGME&R, Kolkata 700020, India
| | | | - Moumita Ghosh
- Neonatology Division, Department of Pediatrics, Medical College and Hospital, Kolkata 700073, India
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Chen K, Song L, Liu B, Wu M, Liu Y, Wang L, Bi J, Liu Q, Zhang Y, Tang Z, Wang Y, Yang R. Low length/weight growth trajectories of early-term infants during the first year: evidence from a longitudinal study in China. BMJ Open 2022; 12:e051436. [PMID: 34980612 PMCID: PMC8724713 DOI: 10.1136/bmjopen-2021-051436] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To identify common length, weight and body mass index (BMI) growth trajectories of term infants during infancy, and to determine their association with early-term infants. DESIGN Prospective longitudinal study. SETTING Wuhan, China. PATIENTS A total of 4308 term infants (born at 37-41 weeks of gestation) were included. All term infants were single live birth with no defects and birth weight ≥2500 g, and their mothers were permanent residents of Wuhan for more than 2 years. After excluding 887 infants, a total of 3421 term infants (1028 early-term infants born at 37-38 weeks of gestation and 2393 full-term infants born at 39-41 weeks of gestation) entered the statistical analysis stage. MAIN OUTCOME MEASURES Patterns of length, weight and BMI growth trajectories by using group-based trajectory modelling. RESULTS Three distinct physical growth trajectories were identified as follows: length: low stable (1056, 30.9%), moderate stable (1887, 55.2%) and high increasing (477, 13.9%); weight: low stable (1031, 30.1%), moderate stable (1884, 55.1%) and high increasing (505, 14.8%); BMI: low stable (689, 20.1%), moderate stable (2167, 63.4%) and high increasing (564, 16.5%). Compared with the full-term infants, early-term infants were more likely to remain at low-stable trajectory in length (OR: 1.40; 95% CI: 1.19 to 1.66) and weight (OR:1.29; 95% CI: 1.09 to 1.53). These associations were still statistically significant after adjusting potential confounders and were more evident among girls in the stratified analysis. There was no statistical association between BMI trajectory patterns and gestational age categories. CONCLUSION Our results suggested the heterogeneity of term infants existed in length, weight and BMI growth trajectories of early childhood. Compared with full-term birth, early-term birth was related to low length and weight trajectories rather than BMI trajectory. Further research is needed to evaluate the duration of these low trajectories and their possible long-term health effects.
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Affiliation(s)
- Kai Chen
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Lulu Song
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Bingqing Liu
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Mingyang Wu
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yunyun Liu
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Lulin Wang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Jianing Bi
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Qing Liu
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yiming Zhang
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - Zezhong Tang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Youjie Wang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Rong Yang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
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Ha S, Martinez V, Chan-Golston AM. Air pollution and preterm birth: A time-stratified case-crossover study in the San Joaquin Valley of California. Paediatr Perinat Epidemiol 2022; 36:80-89. [PMID: 34872160 DOI: 10.1111/ppe.12836] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/23/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Air pollution is linked to preterm birth (PTB), but existing studies are primarily focused on chronic exposures, conducted in areas with moderate pollution, and/or subject to confounding. OBJECTIVES We investigated short-term associations between two pollutants [particulate matter <2.5 microns (PM2.5 ) and ozone] and PTB, and estimated excess PTB cases potentially attributed to these pollutants. METHODS This time-stratified case-crossover study includes 196,970 singleton pregnancies affected by PTB and early term birth from the San Joaquin Valley (SJV), California, USA (2007-2015). Daily ozone and PM2.5 concentrations were estimated by the SJV Air Pollution Control District and geospatially linked to maternal zip code. We used conditional logistic regression models to estimate the odds ratio (OR) and 95% confidence intervals (CI) for the associations between an interquartile range (IQR) increase in pollutants and very preterm (VPTB, 20-34 weeks), moderate preterm (MPTB, 34-36 weeks) and early term births (ETB, 37-38 weeks). We adjusted all models for co-pollutants and meteorological factors. RESULTS During warm seasons (May-October), an IQR increase in ozone was associated with 9-11% increased odds of VPTB from lag 0 (ORlag0 1.09, 95% CI 1.04,1.16) to lag 7 (ORlag7 1.11, 95% CI 1.04,1.16). Findings were consistent for MPTB and ETB. Ozone was potentially responsible for an excess of 3-6 VPTBs, 7-9 PTBs and 24-42 ETBs per 1,000 singleton deliveries. During cold seasons (November-April), increased PM2.5 exposure was associated with 5-6% increased odds of VPTB beginning at lag 3 (ORlag3 1.06, 95% CI 1.02,1.11). PM2.5 was associated with an excess of 1-3 VPTBs, 0-3 MPTBs and 6-18 ETBs per 1,000 singleton deliveries. CONCLUSIONS PM2.5 and ozone are associated with increased risk of VPTB, MPTB and ETB within one week of exposure and are potential contributors to the increasing PTB trend. More research is needed to further understand the role of air pollution on PTB risk.
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Affiliation(s)
- Sandie Ha
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, California, USA.,Health Sciences Research Institute, University of California, Merced
| | - Valerie Martinez
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, California, USA.,Health Sciences Research Institute, University of California, Merced
| | - Alec M Chan-Golston
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, California, USA
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