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Cheng J, Jia X, Yang L, Zhang S, Chen Z, Gui Q, Li T, Pu Z, Qi H, Zhang J. New therapeutic target NCF1-directed multi-bioactive conjugate therapies prevent preterm birth and adverse pregnancy outcomes. Sci Bull (Beijing) 2024; 69:2604-2621. [PMID: 39030102 DOI: 10.1016/j.scib.2024.03.064] [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: 11/08/2023] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 07/21/2024]
Abstract
Preterm birth (PTB) is a leading cause of neonatal morbidity and mortality worldwide, yet the cellular and molecular mechanisms driving this condition remain undeciphered, thus limiting discovery of new therapies. In-depth analyses of human and mouse tissues associated with PTB, in combination with cellular studies, indicated that aberrantly high-expressed neutrophil cytoplasmic factor (NCF) 1 leads to oxidative distress, recruitment, and pro-inflammatory activation of neutrophils and macrophages, while sequentially overexpressed pro-inflammatory mediators induce contractions of uterine smooth muscle cells (USMCs) as well as apoptosis of USMCs and amniotic epithelial cells, thereby causing PTB. According to these new findings, we rationally engineered an amphiphilic macromolecular conjugate LPA by covalently integrating low-molecular-weight heparin, a reactive oxygen species-responsive/scavenging component, and an anti-inflammatory peptide. This bioengineered macromolecular conjugate can self-assemble into multi-bioactive nanoparticles (LPA NP). In a mouse model of PTB, LPA NP effectively delayed PTB and inhibited adverse pregnancy outcomes, by regulating NCF1-mediated oxidative-inflammatory cascades, i.e., attenuating oxidative stress, inhibiting inflammatory cell activation, reducing local inflammation, and decreasing contraction/apoptosis of myometrial cells. Packaging LPA NP into temperature-responsive, self-healing, and bioadhesive hydrogel further potentiated its in vivo efficacies after intravaginal delivery, by prolonging retention time, sustaining nanotherapy release, and increasing bioavailability in the placenta/uterus. Importantly, both the conjugate/nanotherapy and hydrogel formulations exhibited excellent safety profiles in pregnant mice, with negligible side effects on the mother and offspring.
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Affiliation(s)
- Juan Cheng
- Chongqing Key Laboratory of Maternal and Fetal Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; Women and Children's Hospital of Chongqing Medical University, Chongqing 401147, China; Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; Department of Pharmaceutics, College of Pharmacy, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Xiaoyan Jia
- Chongqing Key Laboratory of Maternal and Fetal Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Limei Yang
- Women and Children's Hospital of Chongqing Medical University, Chongqing 401147, China
| | - Siqi Zhang
- Chongqing Key Laboratory of Maternal and Fetal Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Zhiyu Chen
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Qian Gui
- Women and Children's Hospital of Chongqing Medical University, Chongqing 401147, China
| | - Ting Li
- Women and Children's Hospital of Chongqing Medical University, Chongqing 401147, China
| | - Zedan Pu
- Women and Children's Hospital of Chongqing Medical University, Chongqing 401147, China
| | - Hongbo Qi
- Chongqing Key Laboratory of Maternal and Fetal Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; Women and Children's Hospital of Chongqing Medical University, Chongqing 401147, China.
| | - Jianxiang Zhang
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University (Army Medical University), Chongqing 400038, China; Yu-Yue Pathology Scientific Research Center, Chongqing 400039, China; State Key Laboratory of Trauma and Chemical Poisoning, Third Military Medical University (Army Medical University), Chongqing 400038, China.
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Joyner JA, Papermaster AE, Champion JD. Characteristics of late preterm infant readmissions: A systematic review. J Am Assoc Nurse Pract 2024; 36:329-333. [PMID: 38227679 DOI: 10.1097/jxx.0000000000000986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 12/02/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Prematurity represents a critical health disparity. It is important to note that late preterm (LPT) infants comprise the majority of preterm births, yet they are the least studied within the premature population. Evidence-based practice guidelines are now a decade old, indicating the potential need for review and revision. OBJECTIVES This systematic review proposed the assessment of sociodemographic characteristics of LPT infants, clinical practice standards, and associated hospital readmission rates, mortality, and morbidity to determine the need for revision of evidence-based practice guidelines for these infants. DATA SOURCES The Preferred Reporting System Items for Systematic Reviews and Meta Analysis methodology provided the framework for the completion of this review. Literature searches of PubMed/Medline (Ovid), Web of Science, Cumulative Index of Nursing, and Allied Health Literature Plus databases and citation searches included articles published after 2012 using the search terms "late preterm infants," "readmissions," and "readmission rates." CONCLUSIONS The literature search identified 11 studies meeting search criteria. These studies included quasi experimental, retrospective, and prospective cohort studies. These studies highlighted the characteristics of LPT infants that potentially contribute to increased readmission rates, morbidity and mortality rates, health care costs, and long-term health inequities. Overall findings indicate the need for review and revision of evidence-based practice guidelines for these infants. IMPLICATIONS FOR PRACTICE This systematic review manifests the vulnerability of LPT infants and the accompanying need for up-to-date clinical practice guidelines to effectively reduce their morbidity and mortality rates, hospital readmissions rates, and burden of health care costs.
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Düken ME, Yayan EH. The effects of massage therapy and white noise application on premature infants' sleep. Explore (NY) 2024; 20:319-327. [PMID: 37806925 DOI: 10.1016/j.explore.2023.09.002] [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: 02/03/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 10/10/2023]
Abstract
AIM Sleep is vital to premature infants' physical, social and emotional development. The significance of sleep duration, efficiency, and function in premature infants regarding growth development, behavior and neurological development has been increasing. MATERIALS AND METHODS This study was conducted in a randomized controlled experimental design with three groups. Premature infants at 28-37 weeks of gestation who were admitted to the Neonatal Intensive Care Unit of Şanlıurfa Mehmet Akif İnan Training and Research Hospital Haliliye Annex Building were the research population. The sample of the present study consisted of 120 premature infants in the massage therapy group (40), white noise group (40), and control group (40). RESULTS The sleep duration and sleep efficiency of the premature infants in the massage group increased compared to before the application, whereas the number of awakenings and WASO values decreased. The sleep duration of premature infants in the massaged group increased by some five hours. In the white noise group, the sleep duration increased by about two hours than the pre-treatment, and there was an increase in sleep efficiency. White noise application provided a significant decrease in the number of awakenings and WASO values in premature infants. CONCLUSION In this experimental study, which was designed with three groups, it was revealed that massage and white noise application in premature infants were significant non-pharmacological methods to increase sleep duration and sleep efficiency. It was concluded that massage therapy and white noise application is one of the considerable interventions regarding sleep duration, efficiency and functions in premature infants who left the intrauterine period early.
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Affiliation(s)
- Mehmet Emin Düken
- Health Sciences of Faculty, Department of Child Health and Diseases Nursing, Harran University, Şanlıurfa 63000, Turkey.
| | - Emriye Hilal Yayan
- Faculty of Nursing, Department of Child Health and Diseases Nursing, Inönü University, Malatya 44280, Turkey.
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Sentilhes L, Schmitz T, Arthuis C, Barjat T, Berveiller P, Camilleri C, Froeliger A, Garabedian C, Guerby P, Korb D, Lecarpentier E, Mattuizzi A, Sibiude J, Sénat MV, Tsatsaris V. [Preeclampsia: Guidelines for clinical practice from the French College of Obstetricians and Gynecologists]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:3-44. [PMID: 37891152 DOI: 10.1016/j.gofs.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
OBJECTIVE To identify strategies to reduce maternal and neonatal morbidity related to preeclampsia. MATERIAL AND METHODS The quality of evidence of the literature was assessed following the GRADE® method with questions formulated in the PICO format (Patients, Intervention, Comparison, Outcome) and outcomes defined a priori and classified according to their importance. An extensive bibliographic search was performed on PubMed, Cochrane, EMBASE and Google Scholar databases. The quality of the evidence was assessed (high, moderate, low, very low) and recommendations were formulated as a (i) strong, (ii) weak or (iii) no recommendation. The recommendations were reviewed in two rounds with external reviewers (Delphi survey) to select the consensus recommendations. RESULTS Preeclampsia is defined by the association of gestational hypertension (systolic blood pressure≥140mmHg and/or diastolic blood pressure≥90mmHg) and proteinuria≥0.3g/24h or a Proteinuria/Creatininuria ratio≥30mg/mmol occurring after 20 weeks of gestation. Data from the literature do not show any benefit in terms of maternal or perinatal health from implementing a broader definition of preeclampsia. Of the 31 questions, there was agreement between the working group and the external reviewers on 31 (100%). In general population, physical activity during pregnancy should be encouraged to reduce the risk of preeclampsia (Strong recommendation, Quality of the evidence low) but an early screening based on algorithms (Weak recommendation, Quality of the evidence low) or aspirin administration (Weak recommendation, Quality of the evidence very low) is not recommended to reduce maternal and neonatal morbidity related to preeclampsia. In women with preexisting diabetes or hypertension or renal disease, or multiple pregnancy, the level of evidence is insufficient to determine whether aspirin administration during pregnancy is useful to reduce maternal and perinatal morbidity (No recommendation, Quality of the evidence low). In women with a history of vasculo-placental disease, low dose of aspirin (Strong recommendation, Quality of the evidence moderate) at a dosage of 100-160mg per day (Weak recommendation, Quality of the evidence low), ideally before 16 weeks of gestation and not after 20 weeks of gestation (Strong recommendation, Quality of the evidence low) until 36 weeks of gestation (Weak recommendation, Quality of the evidence very low) is recommended. In a high-risk population, additional administration of low molecular weight heparin is not recommended (Weak recommendation, Quality of the evidence moderate). In case of preeclampsia (Weak recommendation, Quality of the evidence low) or suspicion of preeclampsia (Weak recommendation, Quality of the evidence moderate, the assessment of PlGF concentration or sFLT-1/PlGF ratio is not routinely recommended) in the only goal to reduce maternal or perinatal morbidity. In women with non-severe preeclampsia antihypertensive agent should be administered orally when the systolic blood pressure is measured between 140 and 159mmHg or diastolic blood pressure is measured between 90 and 109mmHg (Weak recommendation, Quality of the evidence low). In women with non-severe preeclampsia, delivery between 34 and 36+6 weeks of gestation reduces severe maternal hypertension but increases the incidence of moderate prematurity. Taking into account the benefit/risk balance for the mother and the child, it is recommended not to systematically induce birth in women with non-severe preeclampsia between 34 and 36+6 weeks of gestation (Strong recommendation, Quality of evidence high). In women with non-severe preeclampsia diagnosed between 37+0 and 41 weeks of gestation, it is recommended to induce birth to reduce maternal morbidity (Strong recommendation, Low quality of evidence), and to perform a trial of labor in the absence of contraindication (Strong recommendation, Very low quality of evidence). In women with a history of preeclampsia, screening maternal thrombophilia is not recommended (Strong recommendation, Quality of the evidence moderate). Because women with a history of a preeclampsia have an increased lifelong risk of chronic hypertension and cardiovascular complications, they should be informed of the need for medical follow-up to monitor blood pressure and to manage other possible cardiovascular risk factors (Strong recommendation, Quality of the evidence moderate). CONCLUSION The purpose of these recommendations was to reassess the definition of preeclampsia, and to determine the strategies to reduce maternal and perinatal morbidity related to preeclampsia, during pregnancy but also after childbirth. They aim to help health professionals in their daily clinical practice to inform or care for patients who have had or have preeclampsia. Synthetic information documents are also offered for professionals and patients.
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Affiliation(s)
- Loïc Sentilhes
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France.
| | - Thomas Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, Paris, France
| | - Chloé Arthuis
- Service d'obstétrique et de médecine fœtale, Elsan Santé Atlantique, 44819 Saint-Herblain, France
| | - Tiphaine Barjat
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Saint-Etienne, Saint-Etienne, France
| | - Paul Berveiller
- Service de gynécologie-obstétrique, centre hospitalier intercommunal de Poissy St-Germain, Poissy, France
| | - Céline Camilleri
- Association grossesse santé contre la pré-éclampsie, Paris, France
| | - Alizée Froeliger
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - Charles Garabedian
- Service de gynécologie-obstétrique, University Lille, ULR 2694-METRICS, CHU de Lille, 59000 Lille, France
| | - Paul Guerby
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Toulouse, Toulouse, France
| | - Diane Korb
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, Paris, France
| | - Edouard Lecarpentier
- Service de gynécologie-obstétrique, centre hospitalier intercommunal de Créteil, Créteil, France
| | - Aurélien Mattuizzi
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - Jeanne Sibiude
- Service de gynécologie-obstétrique, hôpital Louis-Mourier, AP-HP, Colombes, France
| | - Marie-Victoire Sénat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Vassilis Tsatsaris
- Maternité Port-Royal, hôpital Cochin, GHU Centre Paris cité, AP-HP, FHU PREMA, Paris, France
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Wang C, Jiang JK, Yin R, Jiang ZD. Suboptimal postnatal function of brainstem auditory pathway in late preterm infants who do not have major perinatal and postnatal complications. Neurophysiol Clin 2023; 53:102919. [PMID: 37984241 DOI: 10.1016/j.neucli.2023.102919] [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: 08/27/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVES To examine postnatal functional status of the brainstem auditory pathway in late preterm infants and detect any postnatal auditory abnormality. METHODS Thirty preterm infants born at 33-36 weeks gestation were studied three months after term. None had major perinatal and postnatal complications to minimize confounding effects. Brainstem auditory evoked responses were recorded with 21-91/s clicks. RESULTS Compared with postnatal age-matched normal term infants, the late preterm infants did not manifest any major abnormalities in brainstem auditory evoked responses at conventionally used 21/s clicks. At higher click rates, however, the late preterm infants manifested a moderate prolongation in BAER wave V latency. All interpeak intervals tended to be prolonged at higher click rates. The I-V interval was significantly prolonged at 51/s and particularly at 91/s clicks. Both the I-III and III-V intervals were significantly prolonged at 91/s. The late preterm infants also manifested reduced amplitudes of BAER waves III and V at most click rates. CONCLUSION The central components of the brainstem auditory evoked responses were abnormal at higher click rates three months after term in the late preterm infants. Postnatal brainstem auditory function is suboptimal in late preterm infants without major complications. This suboptimal brainstem auditory function may not be clearly shown at term or an earlier stage, but can be shown later. Late preterm infants, although they may not have major complications, should be followed for later auditory development, providing valuable information for improving postnatal care.
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Affiliation(s)
- Cui Wang
- Division of Neonatology, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai 201102
| | - James K Jiang
- Division of Neonatology, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai 201102
| | - Rong Yin
- Division of Neonatology, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai 201102
| | - Ze D Jiang
- Division of Neonatology, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai 201102.
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Gupta Basuray R, Cacioppo C, Inuzuka V, Cooper K, Hardy C, Perry MF. Increasing Exclusive Nursery Care of Late Preterm and Low Birth Weight Infants. Hosp Pediatr 2023; 13:992-1000. [PMID: 37818615 DOI: 10.1542/hpeds.2022-007037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Late preterm (LPT) and low birth weight (LBW) infants are populations at increased risk for NICU admission, partly due to feeding-related conditions. This study was aimed to increase the percentage of LPT and LBW infants receiving exclusive nursery care using quality improvement methodologies. METHODS A multidisciplinary team implemented interventions at a single academic center. Included infants were 35 to 36 weeks gestational age and term infants with birth weights <2500 g admitted from the delivery room to the nursery. Drivers of change included feeding protocol, knowledge, and care standardization. We used statistical process control charts to track data over time. The primary outcome was the percentage of infants receiving exclusive nursery care. Secondary outcomes included rates of hypoglycemia, phototherapy, and average weight loss. Balancing measures were exclusive breast milk feeding rates and length of stay. RESULTS Included infants totaled 1336. The percentage of LPT and LBW infants receiving exclusive nursery care increased from 83.9% to 88.8% with special cause variation starting 1 month into the postintervention period. Reduction in neonatal hypoglycemia, 51.7% to 45.1%, coincided. Among infants receiving exclusive nursery care, phototherapy, weight loss, exclusive breast milk feeding, and length of stay had no special cause variation. CONCLUSIONS Interventions involving a nursery feeding protocol, knowledge, and standardization of care for LPT and LBW infants were associated with increased exclusive nursery care (4.9%) and reduced rates of neonatal hypoglycemia (6.6%) without adverse effects. This quality initiative allowed for the preservation of the mother-infant dyad using high-value care.
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Affiliation(s)
- Rakhi Gupta Basuray
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
- Division of Pediatric Hospital Medicine
| | - Carrie Cacioppo
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
- Division of Pediatric Hospital Medicine
| | - Vanessa Inuzuka
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Keri Cooper
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Charles Hardy
- Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, Ohio
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Lockyear C, Coe K, Greenberg RG, Clark RH, Aleem S. Trends in morbidities of late preterm infants in the neonatal intensive care unit. J Perinatol 2023; 43:1379-1384. [PMID: 37393396 DOI: 10.1038/s41372-023-01705-5] [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: 10/31/2022] [Revised: 05/20/2023] [Accepted: 06/15/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE To characterize demographics and trends in length of stay (LOS), morbidities, and mortality in late preterm infants. STUDY DESIGN Cohort study of infants born between 34 0/7 and 36 6/7 weeks gestation between 1999 and 2018 without major congenital anomalies at Pediatrix Medical Group neonatal intensive care units (NICUs). RESULTS 307,967 infants from 410 NICUs met inclusion criteria. The median (25th-75th percentile) LOS was 11 (8-16) days in the entire period. Postmenstrual age (PMA) at discharge increased during the cohort for all gestational ages (p < 0.001). There was a decrease in invasive ventilation, receipt of phototherapy, and reflux medications observed (p < 0.001). CONCLUSION In this large cohort, given 20 years of time for medical advancement, there was no significant improvement in the LOS of late preterm infants. All infants had an increased PMA at discharge, despite multiple practice changes that were observed.
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Affiliation(s)
| | - Kristi Coe
- Duke School of Nursing, Duke University, Durham, NC, USA
| | - Rachel G Greenberg
- Department of Pediatrics, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Reese H Clark
- Pediatrix Center for Research, Education, Quality, and Safety, Sunrise, FL, USA
| | - Samia Aleem
- Department of Pediatrics, Duke University, Durham, NC, USA.
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Purwandari H, Purnamasari MD, Mulyono WA, Huang MC. Preterm infant cues during breastfeeding and its measurement: A scoping review. BELITUNG NURSING JOURNAL 2023; 9:209-217. [PMID: 37492760 PMCID: PMC10363972 DOI: 10.33546/bnj.2445] [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: 11/21/2022] [Revised: 03/29/2023] [Accepted: 04/26/2023] [Indexed: 07/27/2023] Open
Abstract
Background Preterm infants display certain behaviors to communicate their needs, known as preterm infant cues. However, the existing research on preterm infant cues primarily draws from studies conducted on bottle-fed infants rather than breastfed infants. Objective This study aimed to investigate the concept of preterm infant cues during breastfeeding and its appropriate instruments. Design A scoping review. Data Sources The articles published up to January 2022 were searched from multiple sources from EBSCOhost Web, namely CINAHL Plus with Full Text, MEDLINE, ERIC, and E-Journals. Review Methods The articles retrieved for this review were screened using PICO (Population, Intervention, Comparison, and Outcomes) format. Preferred Reporting Items for Systematic Reviews (PRISMA) checklist was used in selecting the articles, and Joanna Briggs Institute Critical Appraisal was utilized by two independent authors to assess the articles' quality. A descriptive method was used to analyze the data. Results The initial review stage found 183 potential articles, but only four satisfied the criteria. The notion of preterm infant cues during breastfeeding is centered on the actions of preterm infants while positioned on their mother's chest. These feeding cues are identifiable before, during, and after breastfeeding and include cues for hunger, self-regulation, stress, satiation, approach, avoidance, and sucking quality. To effectively recognize these cues, tools such as the Preterm Infants Cues Coding System (PFCCS), Infant Driven Scale (IDS), Newborn Individualized Developmental Care and Assessment Program (NIDCAP), and Preterm Breastfeeding Behavior Scale (PIBBS) can be utilized. Conclusion The study findings highlight the importance of recognizing preterm infant cues during breastfeeding to facilitate proper feeding and developmental care. Observational studies have proven to be an effective means of observing these cues during breastfeeding. By leveraging the cues identified in this review alongside tools such as PFCCS, IDS, NIDCAP, and PIBBS, nurses can accurately interpret preterm infants' breastfeeding cues in neonatal care settings of all levels. This, in turn, can aid in developing care plans that promote better feeding ability outcomes.
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Affiliation(s)
- Haryatiningsih Purwandari
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Nursing, Faculty of Health Sciences, Jenderal Soedirman University, Indonesia
| | | | - Wastu Adi Mulyono
- Department of Nursing, Faculty of Health Sciences, Jenderal Soedirman University, Indonesia
| | - Mei-Chih Huang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- National Tainan Junior College of Nursing, Tainan, Taiwan
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Mekic N, Selimovic A, Cosickic A, Mehmedovic M, Hadzic D, Zulic E, Mustafic S, Serak A. Predictors of adverse short-term outcomes in late preterm infants. BMC Pediatr 2023; 23:298. [PMID: 37328827 PMCID: PMC10276478 DOI: 10.1186/s12887-023-04112-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/05/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Infants born between 34 weeks and 36 weeks and 6 days of gestation are defined as late preterm infants (LPIs), and they account for approximately 74% of all premature births. Preterm birth (PB) remains the leading cause of infant mortality and morbidity worldwide. AIM To analyse short-term morbidity and mortality and identify predictors of adverse outcomes in late preterm infants. PATIENTS AND METHODS In this retrospective study, we evaluated adverse short-term outcomes of LPIs admitted to the Intensive Care Unit (ICU), Clinic for Children's Diseases, University Clinical Center Tuzla, between 01.01.2020 and 31.12.2022. The analysed data included sex, gestational age, parity, birth weight, Apgar score (i.e., assessment of vitality at birth in the first and fifth minutes after birth), and length of hospitalization in NICU, as well as short-term outcome data. Maternal risk factors we observed were: age of mother, parity, maternal morbidity during pregnancy, complications and treatment during pregnancy. LPIs with major anatomic malformations were excluded from the study. Logistic regression analysis was used to identify risk factors for neonatal morbidity among LPIs. RESULTS We analysed data from 154 late preterm newborns, most of whom were male (60%), delivered by caesarean Sect. (68.2%) and from nulliparous mothers (63.6%). Respiratory complications were the most common outcome among all subgroups, followed by CNS morbidity, infections and jaundice requiring phototherapy. The rate of almost all of the complications in the late-preterm group decreased as gestational age increased from 34 to 36 weeks. Birth weight (OR: 1,2; 95% CI: 0,9 - 2,3; p = 0,0313) and male sex (OR: 2,5; 95% CI: 1,1-5,4; p = 0,0204) were significantly and independently associated with an increased risk for respiratory morbidity, and gestational weeks and male sex were associated with infectious morbidity. None of the risk factors analysed herein were predictors of CNS morbidity in LPIs. CONCLUSION A younger gestational age at birth is associated with a greater risk of short-term complications among LPIs, thus highlighting the need for increased knowledge about the epidemiology of these late preterm births. Understanding the risks of late preterm birth is critical to optimizing clinical decision-making, enhancing the cost-effectiveness of endeavours to delay delivery during the late preterm period, and reducing neonatal morbidity.
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Affiliation(s)
- Nina Mekic
- Pediatric Department, Health and Educational Medical Center Tuzla, Tuzla, Bosnia and Herzegovina.
| | - Amela Selimovic
- Clinic for Children's Diseases Tuzla, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Almira Cosickic
- Clinic for Children's Diseases Tuzla, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Majda Mehmedovic
- Clinic for Internal Medicine, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Devleta Hadzic
- Clinic for Children's Diseases Tuzla, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Evlijana Zulic
- Clinic for Children's Diseases Tuzla, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Sehveta Mustafic
- Polyclinic for Laboratory Diagnostics University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Amra Serak
- Pediatric Department, Health and Educational Medical Center Tuzla, Tuzla, Bosnia and Herzegovina
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Pradhan P, Mishra R, Panda SK, Panigrahi R, Senapati U, Sarangi R, Panigrahi K. Role of neonatal cerebrospinal fluid cytology in correlation to C-reactive protein, blood culture, risk factors and clinical outcomes in neonatal intensive care. J Family Med Prim Care 2023; 12:932-939. [PMID: 37448924 PMCID: PMC10336944 DOI: 10.4103/jfmpc.jfmpc_980_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 11/29/2022] [Accepted: 12/16/2022] [Indexed: 07/18/2023] Open
Abstract
Introduction The number of neonatal cerebrospinal fluid (CSF) samples sent from the neonatal intensive care unit (NICU) for cytologic examination is rising, warranting accurate analysis and interpretation of the same. This study was taken up to assess the usefulness of CSF cell count and cytology in NICU settings, as it can be used even in a resource-limited setting. Aim and Objective 1) To study the prevalence of cell count and cytologic changes in CSF from NICU and assess their usefulness in correlation to C-reactive protein, CSF neutrophil percentage, blood, CSF culture, and other biochemical parameters. 2) To correlate cell counts and cytology with age, period of gestation, presence, and absence of sepsis, seizures, intracranial hemorrhage, and their clinical follow-up. Materials and Methods A retrospective study was done on neonatal CSF samples submitted for cytology over one year (January-December 2016) in the Department of Pathology. CSF cell counts were retrieved, and cytosmears were reviewed for cellularity, cell type, proportion, and background and correlated with the biochemical, microbiological, and clinicoradiological findings. Results A total of 213 samples were included with 140 males and 73 females with an age range of 0-28 (mean: 7.3) days. The mean CSF cell count was 5.48/cu.mm (0-90 cells/cu.mm). The most frequent cytologic finding was occasional lymphocytes or acellular CSF (63.9%). The CSF leucocyte count and protein levels showed a significant correlation with s C-reactive protein. The CSF cytology showed a significant correlation between the age of the neonate and blood neutrophil percentage (P = 0.0158). History of intracranial hemorrhage showed a significantly higher frequency of the presence of red blood cells (P = 0.0147). Conclusion Accurate cell counts, cytology of neonatal CSF, and biochemical and microbiological workup can help diagnose and manage neonates in intensive care.
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Affiliation(s)
- Prita Pradhan
- Department of Pathology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Reshmi Mishra
- Department of Pediatrics, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Santosh Kumar Panda
- Department of Pediatrics, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Ranjita Panigrahi
- Department of Pathology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Urmila Senapati
- Department of Pathology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Rajlaxmi Sarangi
- Department of Biochemistry, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Kumudini Panigrahi
- Department of Microbiology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
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11
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Dauengauer-Kirlienė S, Domarkienė I, Pilypienė I, Žukauskaitė G, Kučinskas V, Matulevičienė A. Causes of preterm birth: Genetic factors in preterm birth and preterm infant phenotypes. J Obstet Gynaecol Res 2023; 49:781-793. [PMID: 36519629 DOI: 10.1111/jog.15516] [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: 05/06/2022] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022]
Abstract
AIM The aim is to provide an overview of recent research on genetic factors that influence preterm birth in the context of neonatal phenotypic assessment. METHODS This is a nonsystematic review of the recent scientific literature. RESULTS Maternal and fetal genetic diversity and rare genome variants are linked with crucial immune response sites. In addition, more frequent in preterm neonates, de novo variants may lead to attention deficits, hyperactivity, autism spectrum disorders, and infertility of both sexes later in life. Environmental factors may also greatly burden fetal, and consequently, neonatal development and neurodevelopment through a failure in the fetal epigenome reprogramming process and even influence the initiation of spontaneous preterm pregnancy termination. Minimally invasive analysis of the transcription factors associated with preterm birth helps elucidate labor mechanisms and predict its timing. We also provide valuable summaries of genomic and transcriptomic factors that contribute to preterm birth. CONCLUSIONS Investigation of the human genome, epigenome, and transcriptome helps to identify molecular mechanisms linked with preterm delivery and premature newborn clinical appearance in early and late neonatal life and even predict developmental outcomes. Further studies are needed to fully understand the implications of genetic changes in preterm births. These data could be used to develop targeted interventions aimed at selecting the most effective individual treatment and rehabilitation plan.
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Affiliation(s)
- Svetlana Dauengauer-Kirlienė
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ingrida Domarkienė
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ingrida Pilypienė
- Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Gabrielė Žukauskaitė
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Vaidutis Kučinskas
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Aušra Matulevičienė
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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12
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Butorac Ahel I, Tomulić KL, Cicvarić IV, Žuvić M, Dekanić KB, Šegulja S, Čače IB. Incidence and Risk Factors for Glucose Disturbances in Premature Infants. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091295. [PMID: 36143971 PMCID: PMC9501184 DOI: 10.3390/medicina58091295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/26/2022]
Abstract
Background and Objectives: There are limited data regarding the incidence and risk factors for hypoglycemia, hyperglycemia, and unstable glycemia in preterm infants. The aim of the present study was to determine the incidence and risk factors associated with neonatal hypoglycemia, hyperglycemia, and unstable glycemia in preterm infants during the first seven days of life. Materials and Methods: This prospective study included preterm infants <37 weeks of gestation, admitted to the Neonatal Intensive Care Unit between January 2018 and December 2020. Based on blood glucose levels in the first week of life, infants were divided into the following four groups: normoglycemic, hypoglycemic, hyperglycemic, and unstable. Blood glucose levels were measured from capillary blood at the 1st, 3rd, 6th, and 12th hour of life during the first 24 h, and at least once a day from days 2 to 7, prefeed. Results: Of 445 enrolled infants, 20.7% (92/445) were categorized as hypoglycemic, 9.9% (44/445) as hyperglycemic, and 2.9% (13/445) as unstable, respectively. Hypoglycemia was most commonly observed among infants ≥34 weeks (27.9%), and hyperglycemia was most common among preterm infants <28 weeks (50%). Female gender increased the chances of developing hypoglycemia by three times. The decrease in gestational age by one week increased the chance of developing hyperglycemia by 1.9 times. Sepsis increased the chance of developing hyperglycemia seven times, respiratory distress syndrome five times, and mechanical ventilation three times, respectively. Conclusions: Glucose disturbances in the early neonatal period in preterm infants are common and mostly asymptomatic. Therefore, careful blood glucose level monitoring is required in those infants, especially in late preterm infants, in order to prevent possible neurological complications.
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Affiliation(s)
- Ivona Butorac Ahel
- Department of Pediatrics, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Kristina Lah Tomulić
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
- Pediatric Intensive Care Unit, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia
- Correspondence: ; Tel.: +38-551659172
| | - Inge Vlašić Cicvarić
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
- Department of Clinical, Health and Organizational Psychology, Clinical Hospital Center Rijeka, Krešimirova 42, 51000 Rijeka, Croatia
| | - Marta Žuvić
- Department of Biotechnology, University of Rijeka, Radmile Matejčić 2, 51000, Rijeka, Croatia
| | - Kristina Baraba Dekanić
- Department of Pediatrics, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Silvije Šegulja
- Department of Clinical Science, Faculty of Health Studies, University of Rijeka, Viktora Cara Emina 5, 51000 Rijeka, Croatia
| | - Iva Bilić Čače
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
- Neonatal Intensive Care Unit, Department of Pediatrics, Clinical Hospital Center Rijeka, Krešimirova 42, 51000 Rijeka, Croatia
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13
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Keir A, Rumbold A, Collins CT, McPhee AJ, Varghese J, Morris S, Sullivan TR, Leemaqz S, Middleton P, Makrides M, Best KP. Breastfeeding outcomes in late preterm infants: A multi-centre prospective cohort study. PLoS One 2022; 17:e0272583. [PMID: 35969612 PMCID: PMC9377594 DOI: 10.1371/journal.pone.0272583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 07/21/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives To describe (1) infant feeding practices during initial hospitalisation and up to 6 months corrected age (CA) in infants born late preterm with mothers intending to breastfeed, (2) the impact of early feeding practices on hospital length of stay and (3) maternal and infant factors associated with duration of breastfeeding. Methods We conducted a prospective cohort study of infants born at 34+0 to 36+6 weeks gestational age during 2018–2020. Families were followed up until the infant reached 6 months of age (corrected for prematurity). Feeding practices during the birth hospitalisation, length of initial hospital stay, and the prevalence of exclusive or any breastfeeding at 6 weeks, 3 months, and 6 months CA were examined. Associations between maternal and infant characteristics and breastfeeding at 6 weeks, 3 months and 6 months CA were assessed using multivariable logistic regression models. Results 270 infants were enrolled, of these, 30% were multiple births. Overall, 78% of infants received only breastmilk as their first feed, and 83% received formula during the hospitalisation. Seventy-four per cent of infants were exclusively breastfed at discharge, 41% at 6 weeks CA, 35% at 3 months CA, and 29% at 6 months CA. The corresponding combined exclusive and partial breastfeeding rates (any breastfeeding) were 72%, 64%, and 53% of babies at 6 weeks CA, 3 months CA, and 6 months CA, respectively. The mean duration of hospitalisation was 2.9 days longer (95% confidence interval (CI) 0.31, 5.43 days) in infants who received any formula compared with those receiving only breastmilk (adjusted for GA, maternal age, multiple birth, site, and neonatal intensive care unit admission). In multivariable models, receipt of formula as the first milk feed was associated with a reduction in exclusive breastfeeding at 6 weeks CA (odds ratio = 0.22; 95% CI 0.09 to 0.53) and intention to breastfeed >6 months with an increase (odds ratio = 4.98; 95% CI 2.39 to 10.40). Intention to breastfeed >6 months remained an important predictor of exclusive breastfeeding at 3 and 6 months CA. Conclusions Our study demonstrates that long-term exclusive breastfeeding rates were low in a cohort of women intending to provide breastmilk to their late preterm infants, with approximately half providing any breastmilk at 6 months CA. Formula as the first milk feed and intention to breastfeed >6 months were significant predictors of breastfeeding duration. Improving breastfeeding outcomes may require strategies to support early lactation and a better understanding of the ongoing support needs of this population.
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Affiliation(s)
- Amy Keir
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
- Department of Neonatal Medicine, Women’s and Children’s Hospital, North Adelaide, South Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia
- * E-mail:
| | - Alice Rumbold
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia
| | - Carmel T. Collins
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
| | - Andrew J. McPhee
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
| | - Jojy Varghese
- Lyell McEwin Hospital, Elizabeth Vale, South Australia
| | - Scott Morris
- Department of Neonatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Thomas R. Sullivan
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia
| | - Shalem Leemaqz
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
| | - Philippa Middleton
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
| | - Maria Makrides
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
| | - Karen P. Best
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
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Ustun N, Hocaoğlu M, Turgut A, Arslanoğlu S, Ovalı F. Does antenatal corticosteroid therapy improve neonatal outcomes in late preterm birth? J Matern Fetal Neonatal Med 2021; 35:9105-9111. [PMID: 34895004 DOI: 10.1080/14767058.2021.2015576] [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: 10/19/2022]
Abstract
BACKGROUND Infants who are born at 34°/7 to 366/7 weeks of gestation (late preterm) are at greater risk for respiratory and other neonatal morbidities. The objective of this study was to examine the effects of the administration of antenatal corticosteroids (ACS) to women at risk for late preterm delivery on the incidence of neonatal outcomes. METHOD This was a prospective cohort study of singleton gestations at risk of imminent delivery between 34°/7 and 366/7 weeks. Neonatal outcomes were compared between mothers who received ACS and those who did not. The primary outcome was the rate of composite respiratory morbidity defined as the need for treatment within 72 h of life (continuous positive airway pressure or high flow nasal cannula for least 2 h or supplemental oxygen with a fraction of inspired oxygen of at least 0.30 for at least four continuous hours or mechanical ventilation). RESULTS During the 3-year study period, 595 subjects were included in this study, comprising 234 subjects that received ACS and 361 that did not. Administration of ACS significantly reduced the rates of composite respiratory morbidity (aOR 0.63 95% CI 0.40-0.99), the use of CPAP or HFNC for at least 2 h (aOR 0.57 95% CI 0.35-0.94), and transient tachypnea of the newborn (aOR 0.48 95% CI 0.28-0.82). Neonatal hypoglycemia was more significantly increased in the ACS group compared with controls (aOR 1.64 95% CI 1.04-2.59). We found no significant between-group differences in the rate of respiratory distress syndrome, surfactant use, need for resuscitation, jaundice requiring phototherapy, admission to neonatal intensive care or special care nursery, and duration of hospitalization. CONCLUSION Administration of ACS during the late preterm period decreased neonatal respiratory complications, however, increased the rate of hypoglycemia.
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Affiliation(s)
- Nuran Ustun
- Division of Neonatology, Department of Paediatrics, Istanbul Medeniyet University, Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Meryem Hocaoğlu
- Department of Obstetrics and Gynecology, Istanbul Medeniyet University, Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Abdülkadir Turgut
- Department of Obstetrics and Gynecology, Istanbul Medeniyet University, Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Sertaç Arslanoğlu
- Division of Neonatology, Department of Paediatrics, Istanbul Medeniyet University, Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Fahri Ovalı
- Division of Neonatology, Department of Paediatrics, Istanbul Medeniyet University, Göztepe Training and Research Hospital, Istanbul, Turkey
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15
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Sarici SU, Ozcan M, Akpinar M, Altun D, Yasartekin Y, Koklu E, Serdar MA, Sarici D. Transcutaneous Bilirubin Levels and Risk of Significant Hyperbilirubinemia in Early-Term and Term Newborns. J Obstet Gynecol Neonatal Nurs 2021; 50:307-315. [PMID: 33684342 DOI: 10.1016/j.jogn.2021.01.007] [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] [Accepted: 01/01/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To compare the course of the transcutaneous bilirubin (TcB) values of early-term newborns with those of term newborns in the first month of life and to investigate whether early-term newborns have an increased risk of significant hyperbilirubinemia requiring treatment. DESIGN A prospective, controlled cohort analysis. SETTING A tertiary level mother-child birth and health care center. PARTICIPANTS Four hundred early-term (37 0/7 to 38 6/7 weeks) and 320 term (39 0/7 to 41 6/7 weeks) newborns born during a 27-month period. METHODS A total of six TcB measurements in a longitudinal manner were made in early-term and term newborns: the first two at 6 and 48 hours after birth and the next four on routine examination days (Days 4, 7, 15, and 30). Demographic characteristics, values of daily TcB measurements, number of newborns with significant hyperbilirubinemia, and risk of jaundice requiring treatment were compared between the two groups. RESULTS All six TcB values were significantly greater in the early-term group than in the term group (p < .001 for each). Early-term newborns had a statistically significant increased risk of jaundice requiring treatment compared to term newborns (risk ratio = 1.91; 95% confidence interval [1.23-2.96]; p = .0046). Results of the repeated-measures analysis of variance and post hoc adjusted multiple comparison analysis showed that TcB levels increased to and peaked at 96 hours after birth and then gradually decreased to baseline (first measurement) levels at 30 days after birth in each group. CONCLUSIONS Early-term newborns should not be treated as full-term newborns because they have significantly higher TcB levels. These newborns should be closely monitored for pathologic jaundice because they have increased risk for significant hyperbilirubinemia requiring phototherapy.
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16
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Machado MCHDS, Santiloni AFP, Ferrari AP, Parada CMGDL, Carvalhaes MADBL, Tonete VLP. Health care in the first year of life of a prospective cohort of late-preterm and full-term infants, in Botucatu, state of São Paulo, Brazil, 2015-2017. ACTA ACUST UNITED AC 2021; 30:e2020619. [PMID: 34133640 DOI: 10.1590/s1679-49742021000200014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/04/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess association between late-preterm birth and use of referral health services in the first year of life. METHODS This was a prospective cohort study, with data collected from infants at 1, 3, 6, 9 and 12 months old. Maternal and birth characteristics were compared between full-term and late preterm infants. The effect of late preterm birth on the use of specialized outpatient clinic, emergency room/emergency care center, hospitalizations and intensive care unit (ICU) admissions was evaluated by calculating adjusted odds ratios. RESULTS 41 late preterm and 540 full-term infants differed as to frequency of low birth weight and in not staying in joint accommodation, both of which were higher in late-preterm infants, who were also more likely to be admitted to the neonatal ICU (OR=6.85 - 95%CI 2.56;18.34). Late preterm birth was not associated with the use of other referral health services. CONCLUSION late preterm birth was not associated with greater use of referral health services after discharge from maternity hospital.
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Affiliation(s)
| | | | - Anna Paula Ferrari
- Universidade Estadual Paulista 'Júlio de Mesquita Filho', Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil
| | | | | | - Vera Lúcia Pamplona Tonete
- Universidade Estadual Paulista 'Júlio de Mesquita Filho', Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil
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Khasawneh W, Alyousef R, Akawi Z, Al-Dhoon A, Odat A. Maternal and Perinatal Determinants of Late Hospital Discharge Among Late Preterm Infants; A 5-Year Cross-Sectional Analysis. Front Pediatr 2021; 9:685016. [PMID: 34222151 PMCID: PMC8242188 DOI: 10.3389/fped.2021.685016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Although late preterm infants (LPIs) account for the majority of preterm births, they are mistakenly labelled and treated as "near term." Whether longer initial hospital stay improves their outcomes and lowers readmission is controversial. The aim of this study is to identify maternal and perinatal factors associated with longer hospital stay and to assess the rate of readmission. Methods: The medical records of LPIs delivered at an academic center in Jordan over a 5-year period were reviewed. They were divided according to their initial hospital stay into: Early discharge group (ED, ≤ 3 days) and late discharge group (LD, > 3 days). Maternal and perinatal factors associated with > 3-day hospital stay were reported. The rate of readmission was compared between both groups. Results: 2236 LPIs were included in the analysis representing 13% of total births and 81% of premature births. LD group constituted 54%. A thousand two hundred forty three (56%) required admission to NICU. Factors associated with longer hospital stay included maternal prolonged rupture of membranes (AOR 1.9, 95% C.I 1.5, 2.4, p 0.000), C-section delivery (AOR 2.4, 95% C.I 1.9, 3, p 0.001), <35-week gestation (AOR 3.8, 95% C.I 2.6, 5, p 0.000), small-for-gestational age (AOR 1.9, 95% C.I 1.1, 3.8, p 0.03), birthweight <2,500 g (AOR 1.3, 95% C.I 1.1, 1.6, p 0.02), NICU admission (AOR 6.3, 95% C.I 3.4, 11.5, p 0.000), RDS (AOR 2.3, 95% C.I 1.5, 3.6, p 0.005), surfactant therapy (AOR 5, 95% C.I 1.9, 13.5, p 0.001), use of CPAP (AOR 1.7, 95% C.I 1.2, 2.2, p 0.001), jaundice (AOR 11.2, 95% C.I 7.7, 16.2, p 0.000), and sepsis (AOR 10.3, 95% C.I 4.8, 22, p 0.000). Readmission rate was 19% among the LD group and 13% among the ED group. Conclusion: LPIs are at high risk for developing prematurity-related morbidities and the duration of their initial hospital stay can be anticipated based on certain predisposing maternal and perinatal factors. Late discharge of LPIs does not lower the rate of readmission.
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Affiliation(s)
- Wasim Khasawneh
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Rahaf Alyousef
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Zuhour Akawi
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Areen Al-Dhoon
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ahlam Odat
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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18
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Üstün N, Hocaoğlu M, Turgut A, Arslanoğlu S, Ovalı F. Does antenatal corticosteroid therapy improve neonatal outcomes in late preterm birth? J Matern Fetal Neonatal Med 2020; 35:11-17. [PMID: 32854549 DOI: 10.1080/14767058.2020.1808614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Infants who are born at 340/7 to 366/7 weeks of gestation (late preterm) are at greater risk for respiratory and other neonatal morbidities. The objective of this study was to examine the effects of administration of antenatal corticosteroids (ACSs) to women at risk for late preterm delivery on the incidence of neonatal outcomes. METHODS This was a prospective cohort study of singleton gestations at risk of imminent delivery between 340/7 and 366/7 weeks. Neonatal outcomes were compared between mothers who received ACS and those who did not. Primary outcome was the rate of composite respiratory morbidity defined as the need for treatment within 72 h of life (continuous positive airway pressure or high flow nasal cannula for least 2 h or supplemental oxygen with a fraction of inspired oxygen of at least 0.30 for at least four continuous hours or mechanical ventilation). RESULTS During the 3-year study period, 595 subjects were included in this study, comprising 234 subjects that received ACS and 361 that did not. Administration of ACS significantly reduced the rates of composite respiratory morbidity (adjusted odds ratio (aOR) 0.63, 95% confidence interval (CI) 0.40-0.99), the use of CPAP or HFNC for at least 2 h (aOR 0.57, 95% CI 0.35-0.94) and transient tachypnea of newborn (aOR 0.48, 95% CI 0.28-0.82). Neonatal hypoglycemia was more significantly increased in the ACS group compared with controls (aOR 1.64, 95% CI 1.04-2.59). We found no significant between-group differences in the rate of respiratory distress syndrome, surfactant use, need for resuscitation, jaundice requiring phototherapy, admission to neonatal intensive care or special care nursery and duration of hospitalization. CONCLUSION Administration of ACS during the late preterm period decreased neonatal respiratory complications, however, increased the rate of hypoglycemia.
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Affiliation(s)
- Nuran Üstün
- Division of Neonatology, Department of Pediatrics, Göztepe Training and Research Hospital, Istanbul Medeniyet University, İstanbul, Turkey
| | - Meryem Hocaoğlu
- Department of Obstetrics and Gynecology, Göztepe Training and Research Hospital, Istanbul Medeniyet University, İstanbul, Turkey
| | - Abdülkadir Turgut
- Department of Obstetrics and Gynecology, Göztepe Training and Research Hospital, Istanbul Medeniyet University, İstanbul, Turkey
| | - Sertaç Arslanoğlu
- Division of Neonatology, Department of Pediatrics, Göztepe Training and Research Hospital, Istanbul Medeniyet University, İstanbul, Turkey
| | - Fahri Ovalı
- Division of Neonatology, Department of Pediatrics, Göztepe Training and Research Hospital, Istanbul Medeniyet University, İstanbul, Turkey
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19
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Karnati S, Kollikonda S, Abu-Shaweesh J. Late preterm infants - Changing trends and continuing challenges. Int J Pediatr Adolesc Med 2020; 7:36-44. [PMID: 32373701 PMCID: PMC7193066 DOI: 10.1016/j.ijpam.2020.02.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Late preterm infants, defined as newborns born between 340/7-366/7 weeks of gestational age, constitute a unique group among all premature neonates. Often overlooked because of their size when compared to very premature infants, this population is still vulnerable because of physiological and structural immaturity. Comprising nearly 75% of babies born less than 37 weeks of gestation, late preterm infants are at increased risk for morbidities involving nearly every organ system as well as higher risk of mortality when compared to term neonates. Neurodevelopmental impairment has especially been a concern for these infants. Due to various reasons, the rate of late preterm births continue to rise worldwide. Caring for this high risk population contributes a significant financial burden to health systems. This article reviews recent trends in regarding rate of late preterm births, common morbidities and long term outcomes with special attention to neurodevelopmental outcomes.
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Affiliation(s)
- Sreenivas Karnati
- Department of Pediatrics, Cleveland Clinic Children’s, Cleveland, OH, USA
| | - Swapna Kollikonda
- Department of Obstetrics and Gynecology, Women’s Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jalal Abu-Shaweesh
- Department of Pediatrics, Cleveland Clinic Children’s, Cleveland, OH, USA
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20
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Jeong MH, Lee N, Bae MH, Han YM, Park KH, Byun SY. Risk Factors for Delayed Hyperthyrotropinemia in Late Preterm Infants. NEONATAL MEDICINE 2019. [DOI: 10.5385/nm.2019.26.4.204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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21
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Sharma D, Padmavathi IV, Tabatabaii SA, Farahbakhsh N. Late preterm: a new high risk group in neonatology. J Matern Fetal Neonatal Med 2019; 34:2717-2730. [PMID: 31575303 DOI: 10.1080/14767058.2019.1670796] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Late preterm infants are those infants born between 34 0/7 weeks through 36 6/7 week of gestation. These are physiologically less mature and have limited compensatory responses to the extrauterine environment compared with term infants. Despite their increased risk for morbidity and mortality, late preterm newborns are often cared in the well-baby nurseries of hospital after birth and are discharged from the hospital by 2-3 days of postnatal age. They are usually treated like developmentally mature term infants because many of them are of same birth weight and same size as term infants. There is a steady increase in the late preterm birth rate in last decade because of either maternal, fetal, or placental/uterine causes. There has been shift in the distribution of births from term and post-term toward earlier gestations. Although late preterm infants are the largest subgroup of preterm infants, there has been little research on this group until recently. This is mainly because of labeling them as "near-term". Such infants were being looked upon as "almost mature", and were thought as neonate requiring either no or minimal concern. In the obstetric and pediatric practice, late preterm infants are often considered functionally and developmentally mature and often managed by protocols developed for full-term infants. Thus, limited efforts are taken to prolong pregnancy in cases of preterm labor beyond 34 weeks, moreover after 34 weeks most centers do not administer antenatal prophylactic steroids. These practices are based on previous studies reporting neonatal mortality and morbidity in the late preterm period to be only slightly higher in comparison with term infants and whereas in the current scenario the difference is significant. Late preterm infants have 2-3-fold increased risk of morbidities such as hypothermia, hypoglycemia, delayed lung fluid clearance, respiratory distress, poor feeding, jaundice, sepsis, and readmission rates after initial hospital discharge. This leads to huge impact on the overall health care resources. In this review, we cover various aspects of these late preterm infants like etiology, immediate and long-term outcome.
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Affiliation(s)
- Deepak Sharma
- Department of Neonatology, National Institute of Medical Sciences, Jaipur, India
| | | | | | - Nazanin Farahbakhsh
- Department of Pulmonology, Pediatric Department, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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22
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Feeding the Late and Moderately Preterm Infant: A Position Paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr 2019; 69:259-270. [PMID: 31095091 DOI: 10.1097/mpg.0000000000002397] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Nutritional guidelines and requirements for late or moderately preterm (LMPT) infants are notably absent, although they represent the largest population of preterm infants. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition (CoN) performed a review of the literature with the aim to provide guidance on how to feed infants born LMPT, and identify gaps in the literature and research priorities.Only limited data from controlled trials are available. Late preterm infants have unique, often unrecognized, vulnerabilities that predispose them to high rates of nutritionally related morbidity and hospital readmissions. They frequently have feeding difficulties that delay hospital discharge, and poorer rates of breastfeeding initiation and duration compared with term infants. This review also identified that moderately preterm infants frequently exhibit postnatal growth restriction.The ESPGHAN CoN strongly endorses breast milk as the preferred method of feeding LMPT infants and also emphasizes that mothers of LMPT infants should receive qualified, extended lactation support, and frequent follow-up. Individualized feeding plans should be promoted. Hospital discharge should be delayed until LMPT infants have a safe discharge plan that takes into account local situation and resources.In the LMPT population, the need for active nutritional support increases with lower gestational ages. There may be a role for enhanced nutritional support including the use of human milk fortifier, enriched formula, parenteral nutrition, and/or additional supplements, depending on factors, such as gestational age, birth weight, and significant comorbidities. Further research is needed to assess the benefits (improved nutrient intakes) versus risks (interruption of breast-feeding) of providing nutrient-enrichment to the LMPT infant.
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23
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Muganthan T, Boyle EM. Early childhood health and morbidity, including respiratory function in late preterm and early term births. Semin Fetal Neonatal Med 2019; 24:48-53. [PMID: 30348617 DOI: 10.1016/j.siny.2018.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Late preterm (LP) and early term (ET) infants have generally been considered in the same way as their healthy full term (FT) counterparts. It is only in the last decade that an increased risk of later poor health in children born LP has been recognised; evidence for health outcomes following ET birth is still emerging. However, reports are largely consistent in highlighting an increased risk, which lessens approaching FT but is measurable and persists into adolescence and beyond. The most thoroughly explored area to date is respiratory morbidity. This article reviews the body of available evidence for effects of LP birth on pulmonary function and ongoing morbidity, and other areas where an increased risk of health problems has been identified in this population. Implications for delivery of health care are considered and areas for further research are highlighted.
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Affiliation(s)
- Trishula Muganthan
- Neonatal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Elaine M Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK.
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24
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Liao J, Hu R, Su L, Wang S, Xu Q, Qian X, He H. Nonpharmacological Interventions for Sleep Promotion on Preterm Infants in Neonatal Intensive Care Unit: A Systematic Review. Worldviews Evid Based Nurs 2018; 15:386-393. [DOI: 10.1111/wvn.12315] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Jin‐Hua Liao
- School of NursingFujian Medical University Fujian China
| | - Rong‐Fang Hu
- School of NursingFujian Medical University Fujian China
| | - Li‐Jing Su
- School of NursingFujian Medical University Fujian China
| | - Shuo Wang
- School of NursingFujian Medical University Fujian China
| | - Qin Xu
- School of NursingFujian Medical University Fujian China
| | - Xiao‐Fang Qian
- Division of NursingFujian Women's and Children's Hospital Fujian China
| | - Hong‐Gu He
- Alice Lee Centre for Nursing StudiesYong Loo Lin School of MedicineNational University of Singapore Singapore
- National University Health System Singapore
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25
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Chatziioannidis I, Kyriakidou M, Exadaktylou S, Antoniou E, Zafeiriou D, Nikolaidis N. Neurological outcome at 6 and 12 months corrected age in hospitalised late preterm infants -a prospective study. Eur J Paediatr Neurol 2018; 22:602-609. [PMID: 29571948 DOI: 10.1016/j.ejpn.2018.02.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 02/08/2018] [Accepted: 02/27/2018] [Indexed: 11/28/2022]
Abstract
Late preterm infants (34-0/7 to 36-6/7 weeks" gestation) account for 10-20% of NICU admissions and are at increased risk for morbidity and mortality. Although they are prone to developmental delays, reports on neurological outcome during the first 2 years of life are scarce. The aim of the study was to assess neurological/neuromotor outcome in high risk late preterm infants at 6 and 12 months corrected age and the change in neurological scores over time, and to identify factors associated with the neurological outcome. The Hammersmith Infant Neurological Examination was performed in a cohort of 157 late preterm infants admitted in the NICU. The infants were examined at 6 and 12 months corrected age respectively and scored with the optimality score system including 26 items assessing cranial nerve function, posture, movements, tone and reflexes. Also parents reported neurological milestones in the follow up visit. Infants at 6 months had a global score of 59 (47-76) and optimal scores achieved in 25.4%. At 12 months they had a global score of 70 (58-78) and achieved optimal scores in 63.2%. The subscores of posture, tone and reflexes gradually increased from 6 to 12 months corrected age. Being born small for gestational age was the only factor that adversely influenced HINE score at 6 and 12 months. At 12 months 58.5% achieved independent walking. High risk late preterm infants have suboptimal HINE scores at 6 and 12 months of age, suggesting a need for closer follow up and early intervention programs.
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Affiliation(s)
- Ilias Chatziioannidis
- 2nd NICU and Νeonatology Department of Aristotle University of Thessaloniki, G. Papageorgiou Hospital, Thessaloniki, Greece.
| | - Maria Kyriakidou
- Department of Physiotherapy, G. Papageorgiou Hospital, Thessaloniki, Greece.
| | - Sotiria Exadaktylou
- 2nd NICU and Νeonatology Department of Aristotle University of Thessaloniki, G. Papageorgiou Hospital, Thessaloniki, Greece.
| | - Evangelia Antoniou
- 2nd NICU and Νeonatology Department of Aristotle University of Thessaloniki, G. Papageorgiou Hospital, Thessaloniki, Greece.
| | - Dimitrios Zafeiriou
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, G. Hippokration Hospital, Thessaloniki, Greece.
| | - Nikolaos Nikolaidis
- 2nd NICU and Νeonatology Department of Aristotle University of Thessaloniki, G. Papageorgiou Hospital, Thessaloniki, Greece.
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26
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Perszyk DR, Ferguson B, Waxman SR. Maturation constrains the effect of exposure in linking language and thought: evidence from healthy preterm infants. Dev Sci 2018; 21:10.1111/desc.12522. [PMID: 28032433 PMCID: PMC5519447 DOI: 10.1111/desc.12522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 09/20/2016] [Indexed: 01/27/2023]
Abstract
The power of human language rests upon its intricate links to human cognition. By 3 months of age, listening to language supports infants' ability to form object categories, a building block of cognition. Moreover, infants display a systematic shift between 3 and 4 months - a shift from familiarity to novelty preferences - in their expression of this link between language and core cognitive processes. Here, we capitalize on this tightly-timed developmental shift in fullterm infants to assess (a) whether it also appears in preterm infants and (b) whether it reflects infants' maturational status or the duration of their postnatal experience. Healthy late preterm infants (N = 22) participated in an object categorization task while listening to language. Their performance, coupled with that of fullterm infants, reveals that this developmental shift is evident in preterm infants and unfolds on the same maturational timetable as in their fullterm counterparts.
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Affiliation(s)
| | - Brock Ferguson
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Sandra R Waxman
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Institue for Policy Research, Northwestern University, Evanston, IL, USA
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27
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Gunlemez A, Er İ, Baydemir C, Arisoy A. Effects of passive smoking on lung function tests in preschool children born late-preterm: a preventable health priority. J Matern Fetal Neonatal Med 2018; 32:2412-2417. [DOI: 10.1080/14767058.2018.1430759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ayla Gunlemez
- Department of Neonatology, Kocaeli University, Kocaeli, Turkey
| | - İlkay Er
- Department of Neonatology, Kocaeli University, Kocaeli, Turkey
| | - Canan Baydemir
- Department of Biostatistics and Medical Informatics, Kocaeli Universitesi Tip Fakultesi, Kocaeli, Turkey
| | - Ayse Arisoy
- Department of Pediatrics, Kocaeli University, Kocaeli, Turkey
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28
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Makkar A, McCoy M, Hallford G, Escobedo M, Szyld E. A Hybrid Form of Telemedicine: A Unique Way to Extend Intensive Care Service to Neonates in Medically Underserved Areas. Telemed J E Health 2018; 24:717-721. [PMID: 29298407 DOI: 10.1089/tmj.2017.0155] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND More than 90% of neonatal intensive care units (NICUs) in the United States are in urban areas, denying rural residents' easy NICU access. Telemedicine use for patient contact and management, although studied in adults and children, is understudied in neonates. A hybrid telemedicine system, with 24/7 neonatal nurse practitioner coverage and with a neonatologist physically present 3 days per week and telemedicine coverage the remaining days, was recently implemented at Comanche County Memorial Hospital's (CCMH) Level II NICU. OBJECTIVE To compare outcomes of moderately ill infants between 32-35 weeks gestational age (GA) managed by our hybrid telemedicine program with outcomes of similar neonates receiving standard care in a Level IV NICU at Oklahoma University Medical Center (OUMC). DESIGN/METHODS This was a retrospective, noninferiority study comparing outcomes of neonates receiving hybrid telemedicine versus standard care. All 32-35 weeks GA infants admitted between July 2013 and June 2015 were included. OUMC infants came from areas geographically comparable with CCMH. Infants requiring prolonged mechanical ventilation or advanced subspecialty services were excluded. Outcome variables were length of stay, type and duration of respiratory support, length of antibiotic therapy, and time to full enteral feedings. RESULTS Eighty-seven neonates at CCMH and 56 neonates at OUMC were included in the analysis. Compared with neonates at OUMC, neonates at CCMH had shorter hospitalizations, fewer days of supplemental oxygen, and fewer noninvasive ventilation support days, and reached full enteral feeds sooner. CONCLUSIONS The hybrid telemedicine system is a safe and effective strategy for extending intensive care to neonates in medically underserved areas.
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Affiliation(s)
- Abhishek Makkar
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
| | - Mike McCoy
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
| | - Gene Hallford
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
| | - Marilyn Escobedo
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
| | - Edgardo Szyld
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
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29
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Nyqvist KH, Rosenblad A, Volgsten H, Funkquist EL, Mattsson E. Early skin-to-skin contact between healthy late preterm infants and their parents: an observational cohort study. PeerJ 2017; 5:e3949. [PMID: 29104822 PMCID: PMC5667536 DOI: 10.7717/peerj.3949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 10/01/2017] [Indexed: 11/20/2022] Open
Abstract
Background Skin-to-skin contact (SSC) is an important factor to consider in the care of late preterm infants (born between 34 0/7 and 36 6/7 completed weeks of gestation). The literature suggests that SSC between preterm infants and their mothers facilitates breastfeeding. However, more studies are needed to explore potential dose-response effects between SSC and breastfeeding as well as studies that explicitly investigate SSC by fathers among late preterm infants. The aim was to investigate the duration of healthy late preterm infants’ SSC with the mother and father, respectively, during the first 48 h after birth and the associations with breastfeeding (exclusive/partial at discharged), clinical and demographic variables. Methods This was an observational cohort study in which parents to healthy late preterm infants, born between 34 5/7 and 36 6/7 completed weeks of gestation, recorded duration of SSC provided by mother and father, respectively. Demographic and clinical variables were retrieved from the medical records and were used as predictors. Multiple linear regression analysis was used to assess the association between the predictors and the outcome, SSC (hours), separately for mothers and fathers. Results The mean (standard deviation [SD]) time per day spent with SSC with mothers (n = 64) and fathers (n = 64), was 14.7 (5.6) and 4.4 (3.3) hours during the first day (24 h) after birth and 9.2 (7.1) and 3.1 (3.3) hours during the second day (24 h), respectively. Regarding SSC with mothers, no variable was significantly associated with SSC during the first day, while the mean (95% confidence interval [CI]) time of SSC during the second day was 6.9 (1.4–12.4) hours shorter for each additional kg of birthweight (p = 0.014). Concerning SSC with fathers, the mean (95% CI) time of SSC during the first day was 2.1 (0.4–3.7) hours longer for infants born at night (p = 0.015), 1.7 (0.1–3.2) hours longer for boys (p = 0.033), 3.2 (1.2–5.2) hours longer for infants born by caesarean section (p = 0.003), and 1.6 (0.1–3.1) hours longer for infants exclusively breastfed at discharge (p = 0.040). During the second day, the mean (95% CI) time of SSC with fathers was 3.0 (0.6–5.4) hours shorter for each additional kg of birthweight (p = 0.014), 2.0 (0.5–3.6) hours longer for infants born during night-time (p = 0.011), 2.9 (1.4–4.4) hours longer if the mother was primipara (p < 0.001), and 1.9 (0.3–3.5) hours shorter if supplementary artificial milk feeds were given. None of the other predictors, i.e., mother’s age, gestational age, or induction of labor were significantly associated with infants’ SSC with mothers or fathers during any of the first two days after birth. Conclusion Future studies are warranted that investigate duration of SSC between late preterm infants and their parents separately and the associations with breastfeeding and other variables of clinical importance.
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Affiliation(s)
- Kerstin H Nyqvist
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Andreas Rosenblad
- Center for Clinical Research Västerås, Uppsala University, Västerås, Sweden
| | - Helena Volgsten
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Eva-Lotta Funkquist
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Elisabet Mattsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
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30
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Isayama T, Lewis-Mikhael AM, O'Reilly D, Beyene J, McDonald SD. Health Services Use by Late Preterm and Term Infants From Infancy to Adulthood: A Meta-analysis. Pediatrics 2017; 140:peds.2017-0266. [PMID: 28759410 DOI: 10.1542/peds.2017-0266] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Late-preterm infants born at 34 to 36 weeks' gestation have increased risks of various health problems. Health service utilization (HSU) of late-preterm infants has not been systematically summarized before. OBJECTIVES To summarize the published literature on short- and long-term HSU by late-preterm infants versus term infants from infancy to adulthood after initial discharge from the hospital. DATA SOURCES We searched Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, and PsycINFO. STUDY SELECTION Cohort and case-control studies that compared HSU (admissions, emergency department visits, etc) between late-preterm infants and term infants were included. DATA EXTRACTION Data extracted included study design, setting, population, HSU, covariates, and effect estimates. RESULTS Fifty-two articles were included (50 cohort and 2 case-control studies). Meta-analyses with random effect models that used the inverse-variance method found that late-preterm infants had higher chances of all-cause admissions than term infants during all the time periods. The magnitude of the differences decreased with age from the neonatal period through adolescence, with adjusted odds ratios from 2.34 (95% confidence intervals 1.19-4.61) to 1.09 (1.05-1.13) and adjusted incidence rate ratios from 2.62 (2.52-2.72) to 1.14 (1.11-1.18). Late-preterm infants had higher rates of various cause-specific HSU than term infants for jaundice, infection, respiratory problems, asthma, and neurologic and/or mental health problems during certain periods, including adulthood. LIMITATIONS Considerable heterogeneity existed and was partially explained by the variations in the adjustment for multiple births and gestational age ranges of the term infants. CONCLUSIONS Late-preterm infants had higher risks for all-cause admissions as well as for various cause-specific HSU during the neonatal period through adolescence.
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Affiliation(s)
- Tetsuya Isayama
- Departments of Health Research Methods, Evidence, and Impact, .,Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; and
| | | | - Daria O'Reilly
- Departments of Health Research Methods, Evidence, and Impact.,Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Joseph Beyene
- Departments of Health Research Methods, Evidence, and Impact
| | - Sarah D McDonald
- Departments of Health Research Methods, Evidence, and Impact.,Obstetrics and Gynecology, and.,Radiology, McMaster University, Hamilton, Ontario, Canada
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Wang H, Gao X, Liu C, Yan C, Lin X, Dong Y, Sun B, Sun B. Surfactant reduced the mortality of neonates with birth weight ⩾1500 g and hypoxemic respiratory failure: a survey from an emerging NICU network. J Perinatol 2017; 37:645-651. [PMID: 28151493 DOI: 10.1038/jp.2016.272] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/10/2016] [Accepted: 11/11/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We evaluated the efficacy of surfactant therapy and assisted ventilation on morbidity and mortality of neonates with birth weight (BW) ⩾1500 g and hypoxemic respiratory failure (HRF). STUDY DESIGN We retrospectively analyzed 5650 patients with BW ⩾1500 g for incidence, management and outcome of HRF, defined as acute hypoxemia requiring mechanical ventilation and/or nasal continuous positive airway pressure ⩾24 h. The patients were allocated into groups of moderate preterm (1735, 30.7%), late preterm (1431, 25.4%), early term (ETM, 986, 17.5%), full term (1390, 24.6%) and post term (79, 1.4%), with gestational age ⩽33, 34 to 36, 37 to 38, 39 to 41 and ⩾42 weeks, respectively. RESULTS In the five groups, 66.9, 42, 21.6, 12.8 and 5.1% had respiratory distress syndrome (RDS). For pneumonia/sepsis and meconium aspiration syndrome (MAS), the proportion was 13.8%, 25.4%, 38.0%, 52.5% and 76.0%, respectively. Surfactant was given to 21.9% (n=1238) of HRF and 51.2% (n=1108) of RDS. Survival rates of RDS were 82.2%, 87.8%, 84.5%, 77.1% and 75.0%, respectively (numbers needed to treat was 8 to 11 for surfactant benefit). Overall mortality rate of HRF was 21%, or 17.9%, 14.7%, 25.6%, 28.9% and 39.2%, respectively. Mortalities of MAS and pneumonia/sepsis were 29.4 and 27.6%. Relative risk of death was associated with initial disease severity, female gender, mechanical ventilation and congenital anomalies by multivariate logistic regression analysis. CONCLUSION Surfactant was effective for infants with RDS and BW ⩾1500 g, and different incidences and outcome of HRF among GA groups reflected standard of perinatal and respiratory care in emerging neonatal intensive care unit network.
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Affiliation(s)
- H Wang
- Departments of Pediatrics and Neonatology, Children's Hospital of Fudan University, and The Laboratory of Neonatal Diseases of National Health and Family Planning Commission, Shanghai, China
| | - X Gao
- Hunan Provincial Children's Hospital, Changsha, China
| | - C Liu
- Hebei Provincial Children's Hospital, Shijiazhuang, China
| | - C Yan
- First Hospital of Jilin University, Changchun, China
| | - X Lin
- Xiamen Maternity Hospital, Xiamen, China
| | - Y Dong
- Departments of Pediatrics and Neonatology, Children's Hospital of Fudan University, and The Laboratory of Neonatal Diseases of National Health and Family Planning Commission, Shanghai, China
| | - B Sun
- Departments of Pediatrics and Neonatology, Children's Hospital of Fudan University, and The Laboratory of Neonatal Diseases of National Health and Family Planning Commission, Shanghai, China
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32
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Fluid Supplementation versus No Fluid Supplementation in Late Preterm and Term Neonates with Asymptomatic Polycythemia: A Randomized Controlled Trial. Indian Pediatr 2017; 53:983-986. [PMID: 27889725 DOI: 10.1007/s13312-016-0972-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare supplemental intravenous fluids with no supplementation in asymptomatic polycythemic late preterm and term neonates. METHODS 55 infants with venous haematocrit of 65-75 were randomly allocated to receive either 25 mL/kg IV normal saline over 6-8 hours or routine fluids. They were followed up for 48 hours. RESULTS There was no significant difference between fluid supplementation and control groups regarding need for partial exchange transfusion [6/27 (22.2%) vs 8/28 (28.6%); P=0.59]. CONCLUSION We did not find any evidence of clinical benefit with IV fluid supplementation in late preterm and term neonates with asymptomatic polycythemia (PCV 65-75).
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33
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Allen J, Kildea S, Stapleton H. How optimal caseload midwifery can modify predictors for preterm birth in young women: Integrated findings from a mixed methods study. Midwifery 2016; 41:30-38. [PMID: 27498186 DOI: 10.1016/j.midw.2016.07.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/06/2016] [Accepted: 07/15/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE to identify possible mechanisms by which caseload midwifery reduces preterm birth for young childbearing women. DESIGN a mixed methods triangulation, convergence design was used to answer the research question 'How does the way maternity care is provided affect the health and well-being of young women and their babies?' The project generated quantitative and qualitative findings which were collected and analysed concurrently then separately analysed and published. The research design enabled integration of the quantitative and qualitative findings for further interpretation through a critical pragmatic lens. SETTING a tertiary maternity hospital in Australia providing care to approximately 500 pregnant young women (aged 21 years or less) each year. Three distinct models of care were offered: caseload midwifery, young women's clinic, and standard 'fragmented' care. PARTICIPANTS a cohort study included data from 1971 young women and babies during 2008-2012. An ethnographic study included analysis of focus group interviews with four caseload midwives in the young women's midwifery group practice; as well as ten pregnant and postnatal young women receiving caseload midwifery care. FINDINGS integrated analysis of the quantitative and qualitative findings suggested particular features in the model of care which facilitated young women turning up for antenatal care (at an earlier gestation and more frequently) and buying in to the process (disclosing risks, engaging in self-care activities and accepting referrals for assistance). We conceptualised that Optimal Caseload Midwifery promotes Synergistic Health Engagement between midwife and the young woman. KEY CONCLUSIONS optimal Caseload Midwifery (which includes midwives with specific personal attributes and philosophical commitments, along with appropriate institutional infrastructure and support) facilitates midwives and young clients to develop trusting relationships and engage in maternity care. Health engagement can modify predictors for preterm birth that are common amongst pregnant adolescents by promoting earlier maternity booking, sufficient antenatal care, greater emotional resilience, ideal gestational weight gain, less smoking/drug use, and fewer untreated genito-urinary infections. IMPLICATIONS FOR PRACTICE the institutional infrastructure and managerial support for caseload midwifery should value and prioritise the philosophical commitments and personal attributes required to optimise the model. Furthermore the location of visits, between appointment access to primary midwife, and back-up system should be organised to optimise the midwife-woman relationship in order to promote the young woman's engagement with maternity care.
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Affiliation(s)
- J Allen
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Mater Research Institute - University of Queensland and School of Nursing and Midwifery University of Queensland, Level 2, Aubigny Place, Mater Health Services, Raymond Terrace, South Brisbane, QLD 4101, Australia.
| | - S Kildea
- Mater Research Institute - University of Queensland and School of Nursing and Midwifery University of Queensland, Level 1, Aubigny Place, Mater Health Services, South Brisbane, QLD 4101, Australia.
| | - H Stapleton
- Mater Research Institute - University of Queensland and School of Nursing and Midwifery University of Queensland, Level 2, Aubigny Place, Mater Health Services, South Brisbane, QLD 4101, Australia.
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Gomez-Ospina N, Kuo C, Ananth AL, Myers A, Brennan ML, Stevenson DA, Bernstein JA, Hudgins L. Respiratory system involvement in Costello syndrome. Am J Med Genet A 2016; 170:1849-57. [PMID: 27102959 DOI: 10.1002/ajmg.a.37655] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 03/16/2016] [Indexed: 11/09/2022]
Abstract
Costello syndrome (CS) is a multisystem disorder caused by heterozygous germline mutations in the HRAS proto-oncogene. Respiratory system complications have been reported in individuals with CS, but a comprehensive description of the full spectrum and incidence of respiratory symptoms in these patients is not available. Here, we report the clinical course of four CS patients with respiratory complications as a major cause of morbidity. Review of the literature identified 56 CS patients with descriptions of their neonatal course and 17 patients in childhood/adulthood. We found that in the neonatal period, respiratory complications are seen in approximately 78% of patients with transient respiratory distress reported in 45% of neonates. Other more specific respiratory diagnoses were reported in 62% of patients, the majority of which comprised disorders of the upper and lower respiratory tract. Symptoms of upper airway obstruction were reported in CS neonates but were more commonly diagnosed in childhood/adulthood (71%). Analysis of HRAS mutations and their respiratory phenotype revealed that the common p.Gly12Ser mutation is more often associated with transient respiratory distress and other respiratory diagnoses. Respiratory failure and dependence on mechanical ventilation occurs almost exclusively with rare mutations. In cases of prenatally diagnosed CS, the high incidence of respiratory complications in the neonatal period should prompt anticipatory guidance and development of a postnatal management plan. This may be important in cases involving rarer mutations. Furthermore, the high frequency of airway obstruction in CS patients suggests that otorhinolaryngological evaluation and sleep studies should be considered. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Natalia Gomez-Ospina
- Division of Medical Genetics, Stanford University School of Medicine, Stanford, California
| | - Christin Kuo
- Division of Pulmonary Medicine, Stanford University School of Medicine, Stanford, California
| | - Amitha Lakshmi Ananth
- Division of Medical Genetics, Stanford University School of Medicine, Stanford, California
| | - Angela Myers
- Division of Medical Genetics, Stanford University School of Medicine, Stanford, California
| | | | - David A Stevenson
- Division of Medical Genetics, Stanford University School of Medicine, Stanford, California
| | - Jonathan A Bernstein
- Division of Medical Genetics, Stanford University School of Medicine, Stanford, California
| | - Louanne Hudgins
- Division of Medical Genetics, Stanford University School of Medicine, Stanford, California
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Er I, Gunlemez A, Uyan ZS, Aydogan M, Oruc M, Isik O, Arisoy AE, Turker G, Baydemir C, Gokalp AS. Evaluation of lung function on impulse oscillometry in preschool children born late preterm. Pediatr Int 2016; 58:274-8. [PMID: 26455505 DOI: 10.1111/ped.12836] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 08/27/2015] [Accepted: 09/07/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a paucity of data on lung physiology in late-preterm children, who may be exposed to a risk of decline in lung function during childhood. In this study, we evaluated lung function in preschool children born late preterm using impulse oscillometry (IOS), and compared the results with those obtained in healthy term-born children. METHODS Children between 3 and 7 years of age who were born late preterm and who were being followed up at the outpatient clinic were included as the late-preterm group. Age-matched healthy term-born children served as controls. A total of 90 late-preterm and 75 healthy children were included in the study. At 5-20 Hz, resistance (R5-R20), reactance (X5-X20), impedans (Z5) and resonant frequency were measured on IOS. RESULTS Mean IOS R5 and R10 were significantly higher in the late-preterm group than in the control group (P < 0.05). Mean R5, R10 and Z5 were statistically higher in late-preterm children who had been hospitalized for pulmonary infection compared with the control group (P < 0.05). Mean R5, R10, R15, R20 and Z5 were significantly higher, and mean X10 and X15 significantly lower in late-preterm children with passive smoking compared with late-preterm children without passive smoking and controls (P < 0.05). CONCLUSION Children born late preterm had signs of peripheral airway obstruction on IOS-based comparison with healthy term-born controls. Besides the inherent disadvantages of premature birth, hospitalization for pulmonary infection and passive smoking also seemed to adversely affect lung function in children born late preterm.
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Affiliation(s)
- Ilkay Er
- Neonatology Unit, Department of Pediatrics, Kocaeli University, Kocaeli, Turkey
| | - Ayla Gunlemez
- Neonatology Unit, Department of Pediatrics, Kocaeli University, Kocaeli, Turkey
| | - Zeynep Seda Uyan
- Pediatric Pulmonology, Department of Pediatrics, Kocaeli University, Kocaeli, Turkey
| | - Metin Aydogan
- Pediatric Allergy and Immunology Unit, Department of Pediatrics, Kocaeli University, Kocaeli, Turkey
| | - Meral Oruc
- Neonatology Unit, Department of Pediatrics, Kocaeli University, Kocaeli, Turkey
| | - Olcay Isik
- Neonatology Unit, Department of Pediatrics, Kocaeli University, Kocaeli, Turkey
| | - Ayse Engin Arisoy
- Neonatology Unit, Department of Pediatrics, Kocaeli University, Kocaeli, Turkey
| | - Gulcan Turker
- Neonatology Unit, Department of Pediatrics, Kocaeli University, Kocaeli, Turkey
| | - Canan Baydemir
- Biostatistics and Medical Informatics Department, Kocaeli University, Kocaeli, Turkey
| | - Ayse Sevim Gokalp
- Neonatology Unit, Department of Pediatrics, Kocaeli University, Kocaeli, Turkey
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Bulut C, Gürsoy T, Ovalı F. Short-Term Outcomes and Mortality of Late Preterm Infants. Balkan Med J 2016; 33:198-203. [PMID: 27403390 DOI: 10.5152/balkanmedj.2016.16721] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 10/27/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Late preterm infants have increased rates of morbidity and mortality compared to term infants. Determining the risk factors in these infants leads to more comprehensive preventive and treatment strategies. AIMS Our aim was to analyse the morbidity rates such as respiratory system diseases, infections, congenital anomalies, hypoglycemia and hematologic abnormalities and mortality rates in a large group of patients at a referral center. STUDY DESIGN Retrospective cross-sectional study. METHODS Medical records of late preterm and term infants who were managed at the referral center were analysed. RESULTS 41752 births were analysed in 3 years. 71.9% of all births were between 37-42 gestational weeks (i.e. term) and 16.1% were between 34-37 weeks (i.e. late preterm). Compared to term infants, late preterm infants had increased rates of short-term problems. The rate of mortality increased with decreased gestational age. The duration of hospitalization was significantly higher in the smallest late preterm infants. CONCLUSION This study demonstrated the need that late preterm infants who have higher risk for morbidity and mortality, compared to term infants require close monitoring. The rate of mortality and hospitalization increased with decreased gestational age.
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Affiliation(s)
- Cahide Bulut
- Neonatal Intensive Care Unit, Zeynep Kamil Maternity and Children's Diseases Training and Research Hospital, İstanbul, Turkey
| | - Tuğba Gürsoy
- Neonatal Intensive Care Unit, Zeynep Kamil Maternity and Children's Diseases Training and Research Hospital, İstanbul, Turkey
| | - Fahri Ovalı
- Neonatal Intensive Care Unit, Zeynep Kamil Maternity and Children's Diseases Training and Research Hospital, İstanbul, Turkey
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Kim G, Elnabawi O, Shin D, Pae EK. Transient Intermittent Hypoxia Exposure Disrupts Neonatal Bone Strength. Front Pediatr 2016; 4:15. [PMID: 27014665 PMCID: PMC4779887 DOI: 10.3389/fped.2016.00015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 02/22/2016] [Indexed: 12/20/2022] Open
Abstract
A brief intermittent hypoxia (IH, ambient O2 levels alternating between room air and 12% O2) for 1 h immediately after birth resulted in pancreatic islet dysfunction associated with zinc deficiency as previously reported. We hypothesized that IH exposure modulates zinc homeostasis in bone as well, which leads to increased bone fragility. To test this hypothesis, we used neonatal rats and human osteoblasts (HObs). To examine IH influences on osteoblasts devoid of neural influences, we quantified amounts of alkaline phosphatase and mineralization in IH-treated HObs. Bones harvested from IH-treated animals showed significantly reduced hardness and elasticity. The IH group also showed discretely decreased levels of alkaline phosphatase and mineralization amounts. The IH group showed a decreased expression of ZIP8 or Zrt and Irt-like protein 8 (a zinc uptake transporter), Runx2 (or Runt-related transcription factor 2, a master protein in bone formation), Collagen-1 (a major protein comprising the extracellular matrix of the bone), osteocalcin, and zinc content. When zinc was eliminated from the media containing HObs using a zinc chelate and added later with zinc sulfate, Runx2, ZIP8, and osteocalcin expression decreased first, and recovered with zinc supplementation. Adenovirus-mediated ZIP8 over-expression in osteoblasts increased mineralization significantly as well. We conclude that IH impairs zinc homeostasis in bones and osteoblasts, and that such disturbances decrease bone strength, which can be recovered by zinc supplementation.
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Affiliation(s)
- Gyuyoup Kim
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Maryland , Baltimore, MD , USA
| | - Omar Elnabawi
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Maryland , Baltimore, MD , USA
| | | | - Eung-Kwon Pae
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Maryland , Baltimore, MD , USA
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Rather GN, Jan M, Rafiq W, Gattoo I, Hussain SQ, Latief M. Morbidity and Mortality Pattern in Late Preterm Infants at a Tertiary Care Hospital in Jammu & Kashmir, Northern India. J Clin Diagn Res 2015; 9:SC01-4. [PMID: 26816959 PMCID: PMC4717688 DOI: 10.7860/jcdr/2015/16294.6916] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 10/30/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The morbidity and mortality pattern in late preterm infants is higher than term infants (gestational age ≥ 37weeks). The main reason behind that is the relative physiologic and metabolic immaturity, though there is no significant difference in the weight or the size of the two groups. AIM The present study was undertaken to study the incidence, early neonatal morbidity and mortality (within first 7 days of life) in late preterm infants (34 - 36 6/7 weeks). MATERIALS AND METHODS It was a hospital based prospective study conducted from April 2012 to March 2013. The study was conducted in the Department of Paediatrics and Neonatology at G.B. Pant General Hospital and Department of Gynaecology and Obstetrics L.D hospital and G.B. pant general hospital, (associated hospitals of Government Medical College, Srinagar). RESULTS A total of 4100 neonates were included in the study. Incidence of late preterm neonates was 11.58 %. Three hundred sixty five (76.8%) of late preterm and 965 (28.3%) of term infants had at least one of the predefined neonatal conditions. Late preterm infants were at significantly higher risk for overall morbidity due to any cause (p<0.0001), respiratory morbidity (p<0.0001), mechanical ventilation (p=0.0002), jaundice (p<0.0001), hypoglycaemia (p<0.0001), and sepsis (p<0.0001) Perinatal asphyxia (p= 0.186). Early neonatal mortality in late preterm neonates was 2.5% or 25/1000 live births. CONCLUSION Compared with term infants, late preterm infants are at high risk for overall morbidity, respiratory morbidity, and need of mechanical ventilation, jaundice, hypoglycaemia & sepsis. They also have a higher mortality as compared to term neonates.
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Affiliation(s)
- Ghulam Nabi Rather
- Registrar, Department of Pediatrics, Government Medical College, Srinagar, J&K, India
| | - Muzafar Jan
- Professor, Department of Pediatrics, Government Medical College, Srinagar, J&K, India
| | - Wasim Rafiq
- Registrar, Department of Pediatrics, Government Medical CollegeSrinagar, J&K, India
| | - Imran Gattoo
- Registrar, Department of Pediatrics, Government Medical College, Srinagar, J&K, India
| | - Sheikh Quyoom Hussain
- Registrar, Department of Pediatrics, Government Medical College, Srinagar, J&K, India
| | - Mohmad Latief
- Resident, Department of Pediatrics, Government Medical College, Srinagar, J&K, India
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Lau Y, Htun TP, Lim PI, Ho-Lim S, Klainin-Yobas P. Maternal, Infant Characteristics, Breastfeeding Techniques, and Initiation: Structural Equation Modeling Approaches. PLoS One 2015; 10:e0142861. [PMID: 26566028 PMCID: PMC4643938 DOI: 10.1371/journal.pone.0142861] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/26/2015] [Indexed: 11/23/2022] Open
Abstract
Objectives The aim of this study was to examine the relationships among maternal and infant characteristics, breastfeeding techniques, and exclusive breastfeeding initiation in different modes of birth using structural equation modeling approaches. Methods We examined a hypothetical model based on integrating concepts of a breastfeeding decision-making model, a breastfeeding initiation model, and a social cognitive theory among 952 mother-infant dyads. The LATCH breastfeeding assessment tool was used to evaluate breastfeeding techniques and two infant feeding categories were used (exclusive and non-exclusive breastfeeding). Results Structural equation models (SEM) showed that multiparity was significantly positively associated with breastfeeding techniques and the jaundice of an infant was significantly negatively related to exclusive breastfeeding initiation. A multigroup analysis in the SEM showed no difference between the caesarean section and vaginal delivery groups estimates of breastfeeding techniques on exclusive breastfeeding initiation. Breastfeeding techniques were significantly positively associated with exclusive breastfeeding initiation in the entire sample and in the vaginal deliveries group. However, breastfeeding techniques were not significantly associated with exclusive breastfeeding initiation in the cesarean section group. Maternal age, maternal race, gestations, birth weight of infant, and postnatal complications had no significant impacts on breastfeeding techniques or exclusive breastfeeding initiation in our study. Overall, the models fitted the data satisfactorily (GFI = 0.979–0.987; AGFI = 0.951–0.962; IFI = 0.958–0.962; CFI = 0.955–0.960, and RMSEA = 0.029–0.034). Conclusions Multiparity and jaundice of an infant were found to affect breastfeeding technique and exclusive breastfeeding initiation respectively. Breastfeeding technique was related to exclusive breastfeeding initiation according to the mode of birth. This relationship implies the importance of early effective interventions among first-time mothers with jaundice infants in improving breastfeeding techniques and promoting exclusive breastfeeding initiation.
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Affiliation(s)
- Ying Lau
- Department of Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- * E-mail:
| | - Tha Pyai Htun
- Department of Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Peng Im Lim
- Nursing Department, National University Hospital, Singapore
| | - Sarah Ho-Lim
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Piyanee Klainin-Yobas
- Department of Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Allen J, Gibbons K, Beckmann M, Tracy M, Stapleton H, Kildea S. Does model of maternity care make a difference to birth outcomes for young women? A retrospective cohort study. Int J Nurs Stud 2015; 52:1332-42. [DOI: 10.1016/j.ijnurstu.2015.04.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 04/06/2015] [Accepted: 04/13/2015] [Indexed: 10/23/2022]
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Pike KC, Lucas JSA. Respiratory consequences of late preterm birth. Paediatr Respir Rev 2015; 16:182-8. [PMID: 25554628 DOI: 10.1016/j.prrv.2014.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/03/2014] [Accepted: 12/03/2014] [Indexed: 11/30/2022]
Abstract
In developed countries most preterm births occur between 34 and 37 weeks' gestation. Deliveries during this 'late preterm' period are increasing and, since even mild prematurity is now recognised to be associated with adverse health outcomes, this presents healthcare challenges. Respiratory problems associated with late preterm birth include neonatal respiratory distress, severe RSV infection and childhood wheezing. Late preterm birth prematurely interrupts in utero lung development and is associated with maternal and early life factors which adversely affect the developing respiratory system. This review considers 1) mechanisms underlying the association between late preterm birth and impaired respiratory development, 2) respiratory morbidity associated with late preterm birth, particularly long-term outcomes, and 3) interventions which might protect respiratory development by addressing risk factors affecting the late preterm population, including maternal smoking, early life growth restriction and vulnerability to viral infection.
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Affiliation(s)
- Katharine C Pike
- Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Tremona Road, Southampton SO16 6YD, UK; NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK; University College London, Institute of Child Health, 30 Guilford Street London WC1N 1EH, UK.
| | - Jane S A Lucas
- Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Tremona Road, Southampton SO16 6YD, UK; NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK.
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Healthy late preterm infants and supplementary artificial milk feeds: Effects on breast feeding and associated clinical parameters. Midwifery 2015; 31:426-31. [DOI: 10.1016/j.midw.2014.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 11/26/2014] [Accepted: 12/22/2014] [Indexed: 11/18/2022]
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Gladstone M, Oliver C, Van den Broek N. Survival, morbidity, growth and developmental delay for babies born preterm in low and middle income countries - a systematic review of outcomes measured. PLoS One 2015; 10:e0120566. [PMID: 25793703 PMCID: PMC4368095 DOI: 10.1371/journal.pone.0120566] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 01/29/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Premature birth is the leading cause of neonatal death and second leading in children under 5. Information on outcomes of preterm babies surviving the early neonatal period is sparse although it is considered a major determinant of immediate and long-term morbidity. METHODS Systematic review of studies reporting outcomes for preterm babies in low and middle income settings was conducted using electronic databases, citation tracking, expert recommendations and "grey literature". Reviewers screened titles, abstracts and articles. Data was extracted using inclusion and exclusion criteria, study site and facilities, assessment methods and outcomes of mortality, morbidity, growth and development. The Child Health Epidemiology Reference Group criteria (CHERG) were used to assess quality. FINDINGS Of 197 eligible publications, few (10.7%) were high quality (CHERG). The majority (83.3%) report on the outcome of a sample of preterm babies at time of birth or admission. Only 16.0% studies report population-based data using standardised mortality definitions. In 50.5% of studies, gestational age assessment method was unclear. Only 15.8% followed-up infants for 2 years or more. Growth was reported using standardised definitions but recommended morbidity definitions were rarely used. The criteria for assessment of neurodevelopmental outcomes was variable with few standardised tools - Bayley II was used in approximately 33% of studies, few studies undertook sensory assessments. CONCLUSIONS To determine the relative contribution of preterm birth to the burden of disease in children and to inform the planning of healthcare interventions to address this burden, a renewed understanding of the assessment and documentation of outcomes for babies born preterm is needed. More studies assessing outcomes for preterm babies who survive the immediate newborn period are needed. More consistent use of data is vital with clear and aligned definitions of health outcomes in newborn (preterm or term) and intervention packages aimed to save lives and improve health.
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Affiliation(s)
- Melissa Gladstone
- Department of Women and Children’s Health, Institute of Translational Medicine, University of Liverpool, Alder Hey NHS Foundation Trust, Liverpool, United Kingdom
| | - Clare Oliver
- Department of Women and Children’s Health, Institute of Translational Medicine, University of Liverpool, Alder Hey NHS Foundation Trust, Liverpool, United Kingdom
| | - Nynke Van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Suga S, Yasuhi I, Aoki M, Nomiyama M, Kubo N, Kawakami K, Okura N, Okazaki K, Ota A, Kawada K. Risk factors associated with respiratory disorders in late preterm infants. J Matern Fetal Neonatal Med 2015; 29:447-51. [DOI: 10.3109/14767058.2014.1003804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kitsommart R, Phatihattakorn C, Pornladnun P, Paes B. A prospective study of the severity of early respiratory distress in late preterms compared to term infants. J Matern Fetal Neonatal Med 2014; 29:207-12. [DOI: 10.3109/14767058.2014.992335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ratchada Kitsommart
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand,
| | - Chayawat Phatihattakorn
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, and
| | - Pornpat Pornladnun
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand,
| | - Bosco Paes
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Akinloye O, O'Connell C, Allen AC, El-Naggar W. Post-resuscitation care for neonates receiving positive pressure ventilation at birth. Pediatrics 2014; 134:e1057-62. [PMID: 25266427 DOI: 10.1542/peds.2014-0554] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To investigate if postresuscitation care (PRC) is indicated for all infants ≥35 weeks' gestation who receive positive pressure ventilation (PPV) at birth, explore the aspects of this care and the factors most predictive of it. METHODS Our hospital admits any infant who requires PPV at birth to special (intermediate/intensive) neonatal care unit (SNCU) for observation for at least 6 hours. All infants ≥35 weeks' gestation born between 1994 and 2013, who received PPV at birth, were reviewed. We examined perinatal factors that could predict the need for PRC after short (<1 minute) and prolonged (≥1 minute) PPV, admission course, neonatal morbidities, and the aspects of care given. RESULTS Among 87 464 infants born, 3658 (4.2%) had PPV at birth with 3305 (90%) admitted for PRC. Of those, 1558 (42.6%) were in the short PPV group and 2100 (57.4%) in the prolonged PPV group. Approximately 59% of infants who received short PPV stayed in the SNCU for ≥1 day. Infants who received prolonged PPV were more likely to have morbidities and require special neonatal care. Multiple logistic regression analysis revealed the risk factors of placental abruption, assisted delivery, small-for-dates, gestational age <37 weeks, low 5-minute Apgar score, and need for intubation at birth to be independent predictors for SNCU stay ≥1 day and need for assisted ventilation, central lines, and parenteral nutrition. CONCLUSIONS Our data support the need for PRC even for infants receiving short PPV at birth.
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Affiliation(s)
- Olusegun Akinloye
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, and
| | - Colleen O'Connell
- Perinatal Epidemiology Research Unit, Departments of Obstetrics & Gynecology and Pediatrics, Dalhousie University, Halifax, Canada
| | - Alexander C Allen
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, and Perinatal Epidemiology Research Unit, Departments of Obstetrics & Gynecology and Pediatrics, Dalhousie University, Halifax, Canada
| | - Walid El-Naggar
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, and
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Acute histologic chorioamnionitis is a risk factor for adverse neonatal outcome in late preterm birth after preterm premature rupture of membranes. PLoS One 2013; 8:e79941. [PMID: 24324586 PMCID: PMC3851174 DOI: 10.1371/journal.pone.0079941] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 09/30/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The objective of this study was to determine whether acute histologic chorioamnionitis is associated with adverse neonatal outcomes in late preterm infants who were born after preterm PROM. METHODOLOGY/PRINCIPAL FINDINGS The relationship between the presence of acute histologic chorioamnionitis and adverse neonatal outcome was examined in patients with preterm PROM who delivered singleton preterm newborns between 34 weeks and 36 6/7 weeks of gestation. Nonparametric statistics were used for data analysis. The frequency of acute histologic chorioamnionitis was 24% in patients with preterm PROM who delivered preterm newborns between 34 weeks and 36 6/7 weeks of gestation. Newborns born to mothers with histologic chorioamnionitis had significantly higher rates of adverse neonatal outcome (74% vs 51%; p<0.005) than those without histologic chorioamnionitis. This relationship remained significant after adjustment for gestational age at preterm PROM, gestational age at delivery, and exposure to antenatal corticosteroids. CONCLUSIONS/SIGNIFICANCE The presence of acute histologic chorioamnionitis is associated with adverse neonatal outcome in late preterm infants born to mothers with preterm PROM.
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