Survival rate of very low birth weight infants over a quarter century (1994-2019): A single-institution experience

Variations in neonatal mortality of preterm infants with intraparenchymal haemorrhage in Europe: the EPICE cohort

OBJECTIVE

The aim of this study was to investigate variations in mortality before neonatal intensive care unit (NICU) discharge of infants born preterm with intraparenchymal haemorrhage (IPH) in Europe with a special interest for withdrawing life-sustaining therapy (WLST).

DESIGN

Secondary analysis of the Effective Perinatal Intensive Care in Europe (EPICE) cohort, 2011-2012.

SETTING

Nineteen regions in 11 European countries.

PATIENTS

All infants born between 24+0 and 31+6 weeks' gestational age (GA) with a diagnosis of IPH.

MAIN OUTCOME MEASURES

Mortality rate with multivariable analysis after adjustment for GA, antenatal steroids and gender. WLST policies were described among NICUs and within countries.

RESULTS

Among 6828 infants born alive between 24+0 and 31+6 weeks' GA and without congenital anomalies admitted to NICUs, IPH was diagnosed in 234 infants (3.4%, 95% CI 3.3% to 3.9%) and 138 of them (59%) died. The median age at death was 6 days (3-13). Mortality rates varied significantly between countries (extremes: 30%-81%; p<0.004) and most infants (69%) died after WLST. After adjustment and with reference to the UK, mortality rates were significantly higher for France, Denmark and the Netherlands, with ORs of 8.8 (95% CI 3.3 to 23.6), 5.9 (95% CI 1.6 to 21.4) and 4.8 (95% CI 1.1 to 8.9). There were variations in WLST between European regions and countries.

CONCLUSION

In infants with IPH, rates of death before discharge and death after WLST varied between European countries. These variations in mortality impede studying reliable outcomes in infants with IPH across European countries and encourage reflection of clinical practices of WLST across European units.

Risk Factors for Mortality or Major Morbidities of Very Preterm Infants: A Study from Thailand

OBJECTIVE

Very preterm neonates have high rates of composite outcomes featuring mortality and major morbidities. If the modifiable risk factors could be identified, perhaps the rates could be decreased especially in resource-limited settings.

STUDY DESIGN

We performed a prospective study in a Thai neonatal intensive care unit to identify the risk factors of composite outcomes between 2014 and 2021. The inclusion criterion was neonates who were born in our hospital at a gestational age (GA) of less than 32 weeks. The exclusion criteria were neonates who died in the delivery room or had major congenital anomalies. The composite outcomes were analyzed by multivariable logistic regression with adjusted odds ratios (aORs) and a 95% confidence interval (CI).

RESULTS

Over the 8-year study period, 555 very preterm inborn neonates without major birth defects were delivered. The composite outcomes were 29.4% (163/555). The medians (interquartile ranges) of GA and birth weights of the neonates were 29 (27-31) weeks and 1,180 (860-1,475) grams, respectively. By multivariable analysis, GA (aOR: 0.65; 95% CI: 0.55-0.77), small for GA (aOR: 4.93; 95% CI: 1.79-13.58), multifetal gestation (aOR: 2.23; 95% CI: 1.12-4.46), intubation within 24 hours (aOR: 5.39; 95% CI: 1.35-21.64), and severe respiratory distress syndrome (aOR: 5.00; 95% CI: 1.05-23.89) were significantly associated with composite outcomes.

CONCLUSION

Very preterm infants who had a lower GA were small for GA, twins or more, respiratory failure on the first day of life, and severe respiratory distress syndrome were associated with mortality and/or major morbidities.

KEY POINTS

· In very preterm neonates, the composite outcomes and mortality rate were 29.4 and 12.3%.. · Composite outcomes were associated with lower GA, SGA, multifetal gestation, intubation, and severe RDS.. · Mortality was associated with lower GA or Apgar score at 5 minutes, SGA, and PPHN..

Survival Rates of Extremely Low-Birth-Weight Infants in a Tertiary Care Center in Saudi Arabia

Introduction Extremely low birth weight (ELBW) refers to the condition in which an infant is born with a weight of less than one thousand grams (2.2 pounds) at birth. ELBW infants face significant challenges and are at increased risk for various medical complications and developmental issues. ELBW poses unique challenges for infants, families, and healthcare providers. Understanding the causes, consequences, and appropriate management strategies for ELBW is crucial for improving the survival rates of these vulnerable infants. Aim This study aimed to measure the survival rates of ELBW infants in Saudi Arabia and its correlated risk factors. Patients and methods This case-control study was a retrospective chart review analysis of data from King Abdulaziz Medical City (KAMC), a single tertiary care center in Riyadh, Kingdom of Saudi Arabia, and conducted over a four-year period. To estimate the survival rate among all live-birth newborn infants who were born with ELBWs of less than 1000 grams, collected data were tabulated and cleaned in MS Excel, and all data were analyzed using IBM SPSS Statistics for Windows, version 26 (released 2019; IBM Corp., Armonk, New York, United States). Results Two hundred and fifty-six patients were involved. Non-survival rates were 12.9%. In a multivariate regression model, prolonged rupture of membranes (PROM), periventricular leukomalacia (PVL), major intraventricular hemorrhage (IVH), and longer length of stay had increased risks for non-survival, while increasing gestational age, APGAR scores, and cesarean section had decreased risks for non-survival. Survival analysis found that there was a significant mean difference in gestational age (weeks) survival time between normal spontaneous vaginal delivery (NSVD) and cesarean section based on log-rank (Mantel-Cox) (p = 0.008). Conclusion Consistent with the literature, a greater prevalence of ELBW infants survived during hospital stay. Independent risk factors for non-survival include PROM, PVL, major IVH, and long length of stay. Cesarean section, increasing gestational, and APGAR scores were identified as the independent predictors of survival. Prospective studies in nature are required to determine these factors' cause and effect.

Neonatal Birthweight Spectrum: Maternal Risk Factors and Pregnancy Outcomes in Saudi Arabia

Background and Objectives: Low-birth-weight (LBW) neonates are at increased risk of morbidity and mortality which are inversely proportional to birth weight, while macrosomic babies are at risk of birth injuries and other related complications. Many maternal risk factors were associated with the extremes of birthweight. The objectives of this study are to investigate maternal risk factors for low and high birthweight and to report on the neonatal complications associated with abnormal birth weights. Materials and Methods: We conducted a retrospective analysis of medical records of deliveries ≥ 23 weeks. We classified the included participants according to birth weight into normal birth weight (NBW), LBW, very LBW (VLBW), and macrosomia. The following maternal risk factors were included, mother's age, parity, maternal body mass index (BMI), maternal diabetes, and hypertension. The neonatal outcomes were APGAR scores < 7, admission to neonatal intensive care unit (NICU), respiratory distress (RD), and hyperbilirubinemia. Data were analyzed using SAS Studio, multivariable logistic regression analyses were used to investigate the independent effect of maternal risk factors on birthweight categories and results were reported as an adjusted odds ratio (aOR) and 95% Confidence Interval (CI). Results: A total of 1855 were included in the study. There were 1638 neonates (88.3%) with NBW, 153 (8.2%) with LBW, 27 (1.5%) with VLBW, and 37 (2.0%) with macrosomia. LBW was associated with maternal hypertension (aOR = 3.5, 95% CI = 1.62-7.63), while increasing gestational age was less likely associated with LBW (aOR = 0.51, 95% CI = 0.46-0.57). Macrosomia was associated with maternal diabetes (aOR = 3.75, 95% CI = 1.67-8.41), in addition to maternal obesity (aOR = 3.18, 95% CI = 1.24-8.14). The odds of VLBW were reduced significantly with increasing gestational age (aOR = 0.41, 95% CI = 0.32-0.53). In total, 81.5% of VLBW neonates were admitted to the NICU, compared to 47.7% of LBW and 21.6% of those with macrosomia. RD was diagnosed in 59.3% of VLBW neonates, in 23% of LBW, in 2.7% of macrosomic and in 3% of normal-weight neonates. Hyperbilirubinemia was reported in 37.04%, 34.21%, 22.26%, and 18.92% of VLBW, LBW, NBW, and macrosomic newborns, respectively. Conclusions: Most neonates in this study had normal birthweights. Maternal hypertension and lower gestational age were associated with increased risk of LBW. Additionally, maternal obesity and diabetes increased the risk of macrosomia. Neonatal complications were predominantly concentrated in the LBW and VLBW, with a rising gradient as birthweight decreased. The main complications included respiratory distress and NICU admissions.

Trends and characteristics of multiple births in Baoan Shenzhen: A retrospective study over a decade

Background

Shenzhen has the largest and youngest foreign population among all cities in China. The reproductive health of pregnant women from different backgrounds is a social issue that deserves attention. In the past decade, China has liberalized its population policies to stimulate population growth, and the proportion of multiple births has continued to increase.

Method

This retrospective cohort included 526,654 newborns born in Baoan, Shenzhen, from January 1, 2009, to December 31, 2019, including 515,016 singletons and 11,638 twins or triplets. Univariate regression models were used to analyze the effects of maternal sociodemographic characteristics, physiological characteristics, medical history, antenatal care and other factors associated with single vs. multiple births and to elucidate the changing trends of different factors affecting multiple births in the past 11 years. Additionally, fetal development in multiple births was analyzed by generalized linear mixed models.

Results

The rates of pregnancy complications, preterm birth, and advanced-age pregnancy were significantly higher in the multiple birth mothers than in single birth mothers, and more multiple pregnancies were achieved through assisted reproductive technologies. The rates of adverse outcomes such as stillbirth, malformation, hypoxia, and ultralow body weight in multiple fetuses were significantly higher than that in singleton fetuses. The trend analysis from 2009 to 2019 showed that the socioeconomic status and health level of mothers with multiple births improved over time, and the risk during pregnancy generally decreased. Simultaneously, the development indicators of multiple fetuses have improved year by year, and the proportion of adverse outcomes has also decreased significantly. A low pre-natal care utilization rate was shown to be detrimental to the development of multiple fetuses. Independent risk factors for hypoxia and very low birth weight were also identified. The differences in secular trends between two birth groups were further revealed by time series models.

Conclusion

This study presented a comprehensive survey of multiple pregnancies in the area with the largest population inflow in China. This study identified the factors that affect the health of multiple birth mothers and their fetuses, particularly suggesting that preterm birth rates and the use of assisted reproduction remain high. The findings provide a basis for the formulation of individualized pre-natal care, assisted reproductive guidance and healthcare policies for multiple births.

Neurosensory Alterations in Retinopathy of Prematurity: A Window to Neurological Impairments Associated to Preterm Birth

Retinopathy of prematurity (ROP) is one of the main blinding diseases affecting preterm newborns and is classically considered a vascular disorder. The premature exposure to the extrauterine environment, which is hyperoxic in respect to the intrauterine environment, triggers a cascade of events leading to retinal ischemia which, in turn, makes the retina hypoxic thus setting off angiogenic processes. However, many children with a history of ROP show persistent vision impairment, and there is evidence of an association between ROP and neurosensory disabilities. This is not surprising given the strict relationship between neuronal function and an adequate blood supply. In the present work, we revised literature data evidencing to what extent ROP can be considered a neurodegenerative disease, also taking advantage from data obtained in preclinical models of ROP. The involvement of different retinal cell populations in triggering the neuronal damage in ROP was described along with the neurological outcomes associated to ROP. The situation of ROP in Italy was assessed as well.

Nonlinear relationship between early postnatal weight gain velocity and neurodevelopmental outcomes in very-low birth weight preterm infants: A secondary analysis based on a published prospective cohort study

BACKGROUND

Extrauterine growth restriction among the very-low birth weight preterm infants (VLBWPIs) is associated with poorer cognitive development outcome, while the rapid weight gain in infancy increases the long-term risk of obesity and noncommunicable disease among VLBWPIs. However, the results of research on the association between early postnatal growth velocity and neurodevelopmental outcomes in VLBWPIs are still limited and controversial.

OBJECTIVE

We aimed to explore the association between the growth velocity in early postnatal and neurodevelopmental impairment (NDI) among VLBWPIs.

METHODS

This study was a secondary analysis of a previously published prospective cohort. It was based on data on 1,791 premature infants with a birth weight of less than 1500 g, registered in the database of the Premature Baby Foundation of Taiwan between 2007 and 2011. A binary logistic regression model was used to evaluate the association between the weight gain velocity in different periods [from birth to 6 months corrected age (CA), 6 to 12 months CA, and 12 to 24 months CA] and NDI, respectively. The generalized additive model and the smooth curve fitting (penalized spline method) were used to address nonlinearity, and a two-piece-wise binary logistic regression model was added to explain the nonlinearity further.

RESULTS

Nonlinearities were observed between NDI and the weight gain velocity from birth to 6 months CA [inflection point 20.36, <inflection point: odds ratio (OR) = 0.75, 95% confidence interval (CI) 0.67-0.84, >inflection point: OR = 1.01, 95% CI 0.97-1.05], 6-12 months CA [inflection point 9.44, <inflection point: OR = 0.89, 95% CI 0.84-0.94, >inflection point: OR = 1.05, 95% CI 1.05-(1.00, 1.11)], and 12-24 months CA [inflection point 16.00, <inflection point: OR = 0.93, 95% CI 0.88-0.98, >inflection point: OR = 1.75, 95% CI 1.05-(0.96, 3.08)].

CONCLUSION

The neurodevelopmental benefits from a rapid weight gain velocity from birth to 24 months CA might be limited once the growth pace reaches an optimum level. It would help find a pattern of growth that facilitates optimal neurodevelopment, yet minimizes negative health consequences associated with overnutrition further.

Fish oil-containing lipid emulsions prevention on parenteral nutrition-associated cholestasis in very low birth weight infants: a meta-analysis

BACKGROUND

The effect of fish oil-containing lipid emulsions on preventing parenteral nutrition-associated cholestasis (PNAC) in very low birth weight (VLBW) infants is not known. Thus, we conducted a meta-analysis to identify any prevention effect.

METHODS

PubMed, EMBASE, and CENTRAL were searched up to 26 January 2021 for studies related to the preventive effect of fish oil-containing lipid emulsions and fish oil-free lipid emulsions on cholestasis in VLBW infants. Revman 5.3 was used to synthesize the results. A fixed-effect model was used to summarize the data when the heterogeneity was non-significant (I² < 50%), and a random-effects model was used when the heterogeneity was significant (I² > 50%).

RESULTS

Of 728 articles, 11 randomized controlled trials met the inclusion criteria. The meta-analysis indicated that fish oil-containing lipid emulsion reduced the occurrence of PNAC significantly with risk ratio (RR) = 0.53, 95% confidence interval (CI) 0.36-0.80, P = 0.002. The heterogeneity was non-significant with I² = 23%. Subgroup analysis based on parenteral nutrition duration and median birth weight was performed. The synthesis results for patients with parenteral nutrition duration exceeding 14 days revealed I² = 35% (P = 0.15) and pooled RR = 0.47, 95% CI 0.30-0.73, P = 0.0008; and for patients with duration less than 14 days revealed I² = 0% (P = 0.72) and pooled RR = 1.14, 95% CI 0.39-3.35, P = 0.81. The synthesis for patients with birth weight more than 1000 g revealed I² = 0% (P = 0.41) and pooled RR = 0.55, 95% CI 0.26-1.18, P = 0.12; and for patients with birth weight below 1000 g revealed I² = 44% (P = 0.11) and pooled RR = 0.53, 95% CI 0.33-0.85, P = 0.009.

CONCLUSIONS

The fish oil-containing lipid emulsion can reduce the occurrence of PNAC in VLBW infants based on the available original randomized controlled trial studies, especially for patients with parenteral nutrition duration exceeding 14 days and extremely low birth weight infants. Future studies should be performed before a definitive conclusion can be established.