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Garay-Aguilar NV, Reynoso-Rosales LR, Llamo-Vilcherrez AP, Toro-Huamanchumo CJ. Tuberculosis in pregnancy and adverse neonatal outcomes in two peruvian hospitals. Eur J Obstet Gynecol Reprod Biol X 2024; 22:100304. [PMID: 38577130 PMCID: PMC10992712 DOI: 10.1016/j.eurox.2024.100304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/08/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024] Open
Abstract
Background According to the World Health Organization, tuberculosis (TB) ranks among the top 10 causes of death worldwide. The significance of TB during pregnancy lies in its symptoms, which can be mistaken for physiological changes associated with pregnancy. This confusion can lead to maternal-perinatal complications. Objective To evaluate the association between pulmonary TB in pregnancy and adverse neonatal outcomes in two Peruvian hospitals. Methods This is a retrospective cohort study. The target population consisted of pregnant women with and without pulmonary TB whose deliveries were attended at two public hospitals, located in Lima, Peru. The adverse neonatal outcomes were prematurity, low birth weight (LBW), and being small for gestational age (SGA). Crude and adjusted relative risks (RRa) were calculated with their respective 95% confidence intervals (95%CI). Results Information from 212 patients was analyzed; 48.1% had TB during pregnancy, and 23.1% had adverse neonatal outcomes (8%, 11.3%, and 12.3% for LBW, prematurity, and SGA, respectively). In the adjusted model, pregnant women with pulmonary TB had a 3.52 times higher risk of having a newborn with at least one of the adverse outcomes than those who were not exposed (aRR, 3.52; 95%CI: 1.93-6.68). Conclusion Pulmonary TB in pregnancy was jointly and independently associated with adverse neonatal outcomes, including LBW, prematurity, and being SGA.
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Affiliation(s)
| | | | - Anita P. Llamo-Vilcherrez
- Grupo Peruano de Investigación Epidemiológica, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
- OBEMET Center for Obesity and Metabolic Health, Lima, Peru
| | - Carlos J. Toro-Huamanchumo
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
- OBEMET Center for Obesity and Metabolic Health, Lima, Peru
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Jeon GW, Ahn SY, Kim SM, Yang M, Sung SI, Sung JH, Oh SY, Roh CR, Choi SJ, Chang YS. Antenatal Magnesium Sulfate Is Not Associated With Improved Long-Term Neurodevelopment and Growth in Very Low Birth Weight Infants. J Korean Med Sci 2023; 38:e350. [PMID: 37967876 PMCID: PMC10643250 DOI: 10.3346/jkms.2023.38.e350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/06/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Though antenatal magnesium sulfate (MgSO4) is widely used for fetal neuroprotection, suspicions about the long-term neuroprotection of antenatal MgSO4 have been raised. METHODS We investigated short- and long-term outcomes of antenatal MgSO4 use for 468 infants weighing < 1,500 g with a gestational age of 24-31 weeks. RESULTS Short-term morbidities and the risk of developmental delay, hearing loss, and cerebral palsy at a corrected age of 18-24 months and 3 years of age did not decrease in the MgSO4 group (infants who were exposed to MgSO4 for any purpose) or neuroprotection group (infants who were exposed to MgSO4 for fetal neuroprotection) compared with the control group (infants who were not exposed to MgSO4). The z-scores of weight, height, and head circumference did not increase in the MgSO4 group or neuroprotection group compared with the control group. CONCLUSION Antenatal MgSO4 including MgSO4 for neuroprotection did not have beneficial effects on long-term neurodevelopmental and growth outcomes.
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Affiliation(s)
- Ga Won Jeon
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - So Yoon Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su Min Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Misun Yang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se In Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Hee Sung
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Samsung Medical Center, Seoul, Korea
| | - Cheong-Rae Roh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk-Joo Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Samsung Medical Center, Seoul, Korea.
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Rico-Fernández E, Fraire-Martínez MI, Gutiérrez-Palomares ML, Núñez-Enríquez JC, Rico-Fernández MDLP. [Electroencephalographic findings in preterm neonates]. Rev Med Inst Mex Seguro Soc 2023; 61:603-609. [PMID: 37769006 PMCID: PMC10599772 DOI: 10.5281/zenodo.8316443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/03/2023] [Indexed: 09/30/2023]
Abstract
Background The electroencephalogram (EEG) in the newborn period is highly superior to the clinical exam in the detection and prognosis of brain dysfunctions, since it allows continuous functional documentation of the brain at the patient's bedside in a non-invasive way. However, there is still some disagreement about these findings. Objective To describe the electroencephalographic findings in newborns with a history of prematurity. Material and methods Cross-sectional, descriptive, retrospective study. The inclusion criteria were: newborns with a history of prematurity, regardless of gender, who underwent an EEG from June 2017 to June 2021. Patients with incomplete electroencephalographic records or clinical records without complete data were excluded; patients using sedatives (thiopental, fentanyl, midazolam, diazepam) were eliminated from the study. Results 107 patients (37 women and 70 men) with a history of prematurity were included, with a mean gestational age at birth of 30.9 WOG ± 3.25. Electroencephalographic findings were normal in 40%, abnormal in 32%, and immature in 28%. The most frequent abnormal finding was focal paroxysmal activity in 86%. 93.4% of the participants presented comorbidities, the most frequent being neurological. Conclusion Preterm neonates are at high risk of neurologic sequelae, and EEG is a sensitive method for assessing neuromotor and cognitive prognosis. In our study population, one-third had abnormal findings. Early postnatal screening is helpful, but additional records are usually needed to detect high-risk newborns. It would be important to continue studying this line of research in pediatrics.
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Affiliation(s)
- Eduardo Rico-Fernández
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Pediatría “Dr. Silvestre Frenk Freund”, Departamento de Neurofisiología Clínica. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - María Inés Fraire-Martínez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Pediatría “Dr. Silvestre Frenk Freund”, Departamento de Neurofisiología Clínica. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - María Luisa Gutiérrez-Palomares
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Pediatría “Dr. Silvestre Frenk Freund”, Departamento de Neurofisiología Clínica. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Juan Carlos Núñez-Enríquez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Pediatría “Dr. Silvestre Frenk Freund”, División de Investigación en Salud. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - María de la Paz Rico-Fernández
- Instituto Politécnico Nacional, Centro de Investigación y de Estudios Avanzados. Ciudad de México, MéxicoInstituto Politécnico NacionalMéxico
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Galvão da Silva M, Mattiello R, Del Ponte B, Matijasevich A, Silveira MF, Bertoldi AD, Domingues M, Barros F, Santos IS. Breastfeeding Duration and Exclusivity Among Early-Term and Full-Term Infants: A Cohort Study. Curr Dev Nutr 2023; 7:100050. [PMID: 37181939 PMCID: PMC10111589 DOI: 10.1016/j.cdnut.2023.100050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/27/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
Background As compared to full-term infants (39-41 weeks of gestation), early-term infants (37-38 wk) are at increased risk of adverse outcomes, including shorter exclusive breastfeeding (EB) duration and continued breastfeeding. Objectives To compare early-term with full- and late-term infants regarding the prevalence of EB at 3 mo and any breastfeeding at 12 mo. Methods Data sets from two population-based birth cohorts conducted in the city of Pelotas, Brazil, were combined. Only term infants (37 0/7 through 41 6/7 weeks of gestation) were included in the analyses. Early-term infants (37 0/7 through 38 6/7 wk) were compared to the remaining term infants (39 0/7 through 41 6/7 wk). Information on breastfeeding was gathered through maternal interviews at the 3-mo and 12-mo follow-ups. The prevalence of EB at 3 mo and any breastfeeding at 12 mo with 95% CIs were calculated. Crude and adjusted prevalence ratios (PRs) were obtained through Poisson regression. Results A total of 6395 infants with information on gestational age and EB at 3 mo and 6401 infants with information on gestational age and any breastfeeding at 12 mo were analyzed. There was no difference between early-term infants and the remaining term infants regarding the prevalence of EB at 3 mo (29.2% and 27.9%, respectively) (P = 0.248). Prevalence of any breastfeeding at 12 mo was lower in early-term infants than among those born between 39 0/7 and 41 6/7 weeks of gestation (38.2% compared with 42.4%) (P = 0.001). In the adjusted analysis, the PR for any breastfeeding at 12 mo was 15% lower in the early-term group than in the remaining term infants (PR = 0.85; 95% CI: 0.76-0.95) (P = 0.004). Conclusions The prevalence of EB at 3 mo was similar among term infants. Nonetheless, in comparison with the remaining infants born at term, early-term infants were at increased risk of having been weaned before reaching 12 mo of age. Curr Dev Nutr 2023;xx:xx.
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Affiliation(s)
- Michele Galvão da Silva
- Postgraduate Program in Pediatrics and Child Health, Medical School, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rita Mattiello
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Bianca Del Ponte
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rio Grande do Sul, Brazil
| | - Alicia Matijasevich
- Department of Preventive Medicine, Faculdade de Medicina da Universidade de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Mariangela F. Silveira
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rio Grande do Sul, Brazil
| | - Andrea D. Bertoldi
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rio Grande do Sul, Brazil
| | - Marlos Domingues
- Postgraduate Program in Physical Education, Universidade Federal de Pelotas, Rio Grande do Sul, Brazil
| | - Fernando Barros
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rio Grande do Sul, Brazil
- Postgraduate Program in Health and Behaviour, Universidade Católica de Pelotas, Rio Grande do Sul, Brazil
| | - Ina S. Santos
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rio Grande do Sul, Brazil
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Jeon GW, Lee JH, Oh M, Chang YS. Serial Long-Term Growth and Neurodevelopment of Very-Low-Birth-Weight Infants: 2022 Update on the Korean Neonatal Network. J Korean Med Sci 2022; 37:e263. [PMID: 36038959 PMCID: PMC9424698 DOI: 10.3346/jkms.2022.37.e263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/27/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND We aimed to evaluate the long-term growth and neurodevelopmental outcomes of very-low-birth-weight infants (VLBWIs, birth weight < 1,500 g) born between 2013, the establishment of the Korean Neonatal Network (KNN), and 2018, both at 18-24 months of corrected age and three years of age, using a nationwide large cohort, and to evaluate whether these outcomes have improved over time since 2013. METHODS This study used data from the annual reports of the KNN for 18-24 months of corrected age (follow-up 1) and three years of age (follow-up 2). Follow-up 1 data were collected from 10,065 eligible VLBWIs born between January 1, 2013, and December 31, 2018. Follow-up 2 data were collected from 8,156 eligible VLBWIs born between January 1, 2013, and December 31, 2017. RESULTS The overall follow-up rates of VLBWIs at follow-ups 1 and 2 were 74.6% (7,512/10,065) and 57.7% (4,702/8,156), respectively. The overall mortality rate between discharge from the neonatal intensive care unit and follow-up 1 was 1% (104/10,065). The overall mortality rate between follow-ups 1 and 2 was 0.049% (4/8,156). Growth restrictions decreased over time, especially weight growth restrictions, which significantly decreased according to era (17% in infants born in 2013-2014 and 13% in infants born in 2017-2018). Fewer infants were re-hospitalized and required rehabilitative support according to era at follow-up 1. More infants had language developmental delays and required language support according to era, both at follow-ups 1 and 2. The incidence of cerebral palsy has significantly decreased over time, from 6% in infants born in 2013-2014 to 4% in infants born in 2017-2018 at follow-up 1, and from 8% in infants born in 2013-2014 to 5% in infants born in 2017 at follow-up 2. CONCLUSION Long-term outcomes of VLBWIs regarding weight growth and cerebral palsy, the most common motor disability in childhood, have improved serially according to era since 2013. However, the rate of infants with language delays requiring language support has increased according to era. Further studies are required on the increased trends of language delay and language support while improving motor outcomes.
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Affiliation(s)
- Ga Won Jeon
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Jang Hoon Lee
- Department of Pediatrics, Ajou University School of Medicin, Suwon, Korea
| | - Minkyung Oh
- Department of Pharmacology, Inje University College of Medicine, Busan, Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Samsung Medical Center, Seoul, Korea.
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Jeon GW, Lee JH, Oh M, Chang YS. Serial Short-Term Outcomes of Very-Low-Birth-Weight Infants in the Korean Neonatal Network From 2013 to 2020. J Korean Med Sci 2022; 37:e229. [PMID: 35880505 PMCID: PMC9313972 DOI: 10.3346/jkms.2022.37.e229] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/20/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND We aimed to determine the current survival rate and short-term outcomes of very-low-birth-weight infants (VLBWIs) in Korea, as well as whether the survival rate and short-term outcomes have improved over time since 2013, which was when the Korean Neonatal Network (KNN) was launched. METHODS This study used data from the annual reports of the KNN from 2013 to 2020. A total of 16,351 VLBWIs born at gestational age (GA) ≥ 22 weeks between January 1, 2013, and December 31, 2020, and who were registered in the KNN were enrolled. Serial outcomes were analyzed according to era (2013-14, 2015-16, 2017-18, and 2019-20). RESULTS More mothers delivered by cesarean section, had diabetes or hypertension during their pregnancy, and received antenatal steroids when analyzed by era. Fewer infants were intubated at birth and had air leaks when analyzed by era. The overall survival rate of VLBWIs between 2013 and 2020 was 87%. The rate of respiratory distress syndrome was 77% and that of bronchopulmonary dysplasia was 32% between 2013 and 2020. The rates of intraventricular hemorrhage (grade ≥ 3), periventricular leukomalacia, and sepsis decreased over time. The survival rate of infants with a GA of 26 weeks has improved serially according to era. CONCLUSION Since the launch of the KNN in 2013, the survival rates of infants with GA 26 weeks and short-term outcomes have improved, which implies a quality improvement in antenatal and delivery room care. Further studies on the long-term neurodevelopmental outcomes of these KNN registrants are warranted.
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Affiliation(s)
- Ga Won Jeon
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Jang Hoon Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Minkyung Oh
- Department of Pharmacology, Inje University College of Medicine, Busan, Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Diaz Rojas MC, Peralta Rodríguez JE, Soto Béjar OA. [Intracardiac fungal mass in extreme premature patient]. Arch Peru Cardiol Cir Cardiovasc 2022; 3:166-171. [PMID: 37284573 PMCID: PMC10241330 DOI: 10.47487/apcyccv.v3i2.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/28/2022] [Indexed: 06/08/2023]
Abstract
There are few reports on intracardiac fungal masses, especially in the pediatric population. We present the case of an extremely premature patient who, after being hospitalized since birth in an intensive care unit, developed fungal masses in the right atrium, which, due to their size, location and resistance to medical treatment, required surgical excision. For this reason, at the slightest suspicion of systemic candidiasis in pediatric patients, it is mandatory to include an echocardiogram in the defocalization examinations to rule out endocarditis and thus avoid the development of intracardiac fungal masses. Therefore, early detection for timely medical management may avoid the surgical approach associated with a high risk of morbidity and mortality in extremely premature patients.
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Affiliation(s)
- Milagros C Diaz Rojas
- Instituto Nacional de Salud del Niño San Borja. Lima, Perú Instituto Nacional de Salud del Niño San Borja Lima Perú
| | - Julio E Peralta Rodríguez
- Instituto Nacional de Salud del Niño San Borja. Lima, Perú Instituto Nacional de Salud del Niño San Borja Lima Perú
| | - Oscar A Soto Béjar
- Instituto Nacional de Salud del Niño San Borja. Lima, Perú Instituto Nacional de Salud del Niño San Borja Lima Perú
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Narciso LM, Beleza LO, Imoto AM. The effectiveness of Kangaroo Mother Care in hospitalization period of preterm and low birth weight infants: systematic review and meta-analysis. J Pediatr (Rio J) 2022; 98:117-125. [PMID: 34274324 PMCID: PMC9432036 DOI: 10.1016/j.jped.2021.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of kangaroo mother care (KMC) in reducing the length of hospital stay of preterm and/or low birth weight infants. SOURCE Cochrane Library, Pubmed, Embase, LILACS, and Scielo. Randomized clinical trials without time or language limit were included. The intervention was the KMC in preterm and/or low birth weight infants born in health facilities compared to conventional care. The article selection was performed by a pair of reviewers independently. The methodological quality assessment was performed using the tool Risk of Bias 2. SUMMARY OF THE FINDINGS Eight hundred and sixty-four citations were identified and 12 were selected for data extraction. There was a reduction in the length of hospital stay in days in the KMC group compared to the conventional care group, with a statistically significant difference (MD -1.75, 95% CI -3.22 to -0.28). The subgroup that underwent the intervention for more than six hours daily did not show a statistical difference for the length of hospital stay outcome (MD -0.79, 95% CI -2.52 to 0.90), while the subgroup that underwent the intervention for less than six hours daily showed a reduction in this outcome with a statistically significant difference (MD -4.66, 95% CI -7.15 to -2.17). CONCLUSIONS KMC is a safe and low-cost intervention that has been shown to be effective in reducing the length of hospital stay of preterm and/or low birth weight infants.
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Affiliation(s)
- Letícia M Narciso
- Escola Superior em Ciências da Saúde, Secretaria de Saúde do Distrito Federal, Programa de Mestrado Profissional, Brasília, DF, Brazil.
| | - Ludmylla O Beleza
- Hospital Materno Infantil de Brasília, Unidade de Neonatologia, Brasília, DF, Brazil
| | - Aline M Imoto
- Escola Superior em Ciências da Saúde, Programa de Mestrado Profissional e Acadêmico, Brasília, DF, Brazil; Escola Superior em Ciências da Saúde, Programa Stricto Sensu em Ciências da Saúde, Brasília, DF, Brazil
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Gharehbaghi MM, Ganji S, Mahallei M. A Randomized Clinical Trial of Intratracheal Administration of Surfactant and Budesonide Combination in Comparison to Surfactant for Prevention of Bronchopulmonary Dysplasia. Oman Med J 2021; 36:e289. [PMID: 34447583 PMCID: PMC8376750 DOI: 10.5001/omj.2021.84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/14/2020] [Indexed: 11/03/2022] Open
Abstract
Objectives Bronchopulmonary dysplasia (BPD) remains a major problem in preterm infants occurring in up to 50% of infants born at < 28 weeks gestational age. Inflammation plays an important role in the pathogenesis of BPD. This study was conducted to evaluate the efficacy of intratracheal budesonide administration in combination with a surfactant in preventing BPD in preterm infants. Methods In a randomized clinical trial, 128 preterm infants at < 30 weeks gestational age and weighing < 1500 g at birth were studied. All had respiratory distress syndrome (RDS) and needed surfactant replacement therapy. They were randomly allocated into two groups; surfactant group (n = 64) and surfactant + budesonide group
(n = 64). Neonates in the surfactant group received intratracheal Curosurf 200 mg/kg/dose. Patients in the surfactant + budesonide group were treated with intratracheal instillation of a mixed suspension of budesonide 0.25 mg/kg and Curosurf 200 mg/kg/dose. Neonates were followed untill discharge for the primary outcome which was BPD and secondary outcomes including sepsis, patent ductus arteriosus (PDA), retinopathy of prematurity (ROP), and necrotizing enterocolitis (NEC). Results The mean gestational age and birth weight of the studied neonates were 28.3±1.6 weeks and 1072.0±180.0 g, respectively. The demographic characteristics and RDS score were similar in the two groups. BPD occurred in 24 (37.5%) neonates in the surfactant + budesonide group and 38 (59.4%) neonates in surfactant group, p = 0.040. Hospital stay was 29.7±19.2 days (median = 30 days) in the surfactant group and 23.3±18.1 days (median = 20 days) in the surfactant + budesonide group, p = 0.050. The rates of sepsis, PDA, ROP, and NEC were not significantly different in the two groups. Conclusions The use of budesonide in addition to surfactant for rescue therapy of RDS in preterm infants decreases the incidence of BPD and duration of respiratory support significantly. Large adequately powered clinical trials with long-term safety assessments are needed to confirm our findings before its routine use can be recommended.
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Affiliation(s)
| | - Shalale Ganji
- Pediatrics and Neonatology Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid Mahallei
- Pediatrics and Neonatology Department, Tabriz University of Medical Sciences, Tabriz, Iran
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Abstract
Extremely low birth weight (ELBW) infants are at particularly high risk for infection due to an immature immune system, invasive procedures such as endotracheal intubation, intravascular catheterization, and other factors. Neonatal infections in this population are associated with a high mortality, poor growth, and neurodevelopmental outcomes. Pseudomonas aeruginosa (P. aeruginosa) infection is an uncommon but potentially devastating cause of pneumonia and sepsis in the ELBW population. P. aeruginosa is an important cause of healthcare-associated infections (HAI) or nosocomial infections. P. aeruginosa can perceive unfavorable environmental changes and orchestrate adaptations by developing plasmid-mediated and adaptive resistance to antibiotics. We describe an ELBW infant born at 26 weeks’ gestation who succumbed at 13 days of life to P. aeruginosa infection. Some of the factors related to the pathogenesis and multidrug resistance are described.
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Affiliation(s)
- Ranjit I Kylat
- University of Arizona, College of Medicine, Department of Pediatrics, Tucson, Arizona, USA
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Abstract
Preterm neonates with severe thrombocytopenia are frequently prescribed prophylactic platelet transfusions despite no evidence of benefit. Neonatal platelet transfusion practice varies, both nationally and internationally. Volumes and rates of transfusion in neonatology are based on historic precedent and lack an evidence base. The etiology of harm from platelet transfusions is poorly understood. Neonates are expected to be the longest surviving recipients of blood produce transfusions, and so avoiding transfusion associated harm is critical in this cohort. This article reviews the evidence for and against platelet transfusion in the neonate and identifies areas of future potential neonatal platelet transfusion research.
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Affiliation(s)
- Carmel Maria Moore
- Department of Neonatology, National Maternity Hospital, Dublin 2, D02YH21, Ireland.
| | - Anna E Curley
- Department of Neonatology, National Maternity Hospital, Dublin 2, D02YH21, Ireland
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Kang JH, Son H, Byun SY, Han G. [Effect of Direct Breastfeeding Program for Premature Infants in Neonatal Intensive Care Unit]. J Korean Acad Nurs 2021; 51:119-132. [PMID: 33706336 DOI: 10.4040/jkan.20240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to identify the effects of a direct breastfeeding program for premature infants in neonatal intensive care units (NICUs). METHODS This quasi-experimental study was conducted during August 2016 to April 2017. Sixty mothers of premature infants were assigned to the experimental (n = 31) or control groups (n = 29). The program was comprised of breastfeeding education and direct breastfeeding support. The experimental and control groups were provided with education and counseling on breastfeeding at the time of admission and discharge. In the experimental group, the mothers initiated oral feeding with direct breastfeeding and engaged in breastfeeding at least seven times during the NICU stay. The collected data were analyzed by the χ²-test and repeated measures ANOVA using an SPSS program. RESULTS The experimental group showed a higher direct breastfeeding practice rate (χ² = 19.29, p < .001), breastfeeding continuation rate (χ² = 3.76, p < .001), and self-efficacy (F = 25.37, p < .001) than the control group except for maternal attachment. CONCLUSION The direct breastfeeding program in the NICU has significant effects on the practice and continuation rate of breastfeeding and breastfeeding self-efficacy. Therefore, this program can be applied in the NICU settings where direct breastfeeding is limited.
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Affiliation(s)
- Ji Hyun Kang
- Department of Nursing, Pusan National University Hospital, Busan, Korea
| | - Hyunmi Son
- College of Nursing, Pusan National University, Yangsan, Korea.
| | - Shin Yun Byun
- Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
| | - Gyumin Han
- College of Nursing, Pusan National University, Yangsan, Korea
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Alcorta-García MR, López-Villaseñor CN, Sánchez-Ferrer G, Flores-Mendoza H, Castorena-Torres F, Aguilar-Torres MA, Sepúlveda-Treviño CM, Hernández-Hernández JA, López-Sánchez RC, Lara-Díaz VJ. Modulation of CYP2E1 metabolic activity in a cohort of confirmed caffeine ingesting pregnant women with preterm offspring. Mol Cell Pediatr 2020; 7:4. [PMID: 32476096 PMCID: PMC7261717 DOI: 10.1186/s40348-020-00096-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 05/18/2020] [Indexed: 11/15/2022] Open
Abstract
Background To ascertain interactions of caffeine ingestion, food, medications, and environmental exposures during preterm human gestation, under informed consent, we studied a cohort of Mexican women with further preterm offspring born at ≤ 34 completed weeks. At birth, blood samples were taken from mothers and umbilical cords to determine caffeine and metabolites concentrations and CYP1A2 (rs762551) and CYP2E1 (rs2031920, rs3813867) polymorphisms involved in caffeine metabolism. Results In 90 pregnant women who gave birth to 98 preterm neonates, self-informed caffeine ingestion rate was 97%, laboratory confirmed rate was 93 %. Theobromine was the predominant metabolite found. Consumption of acetaminophen correlated significantly with changes in caffeine metabolism (acetaminophen R2 = 0.637, p = 0.01) due to activation of CYP2E1 alternate pathways. The main caffeine source was cola soft drinks. Conclusion Environmental exposures, especially acetaminophen ingestion during human preterm pregnancy, can modulate CYP2E1 metabolic activity.
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Affiliation(s)
- M R Alcorta-García
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Avenida Ignacio Morones Prieto 3000 poniente, Colonia Doctores, CP 64710, Monterrey, Nuevo León, México.,Hospital Regional Materno Infantil, Secretaria de Salud, Gobierno del Estado de Nuevo León, Avenida San Rafael 450, Colonia San Rafael, CP 67140, Ciudad Guadalupe, Nuevo León, México
| | - C N López-Villaseñor
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Avenida Ignacio Morones Prieto 3000 poniente, Colonia Doctores, CP 64710, Monterrey, Nuevo León, México.,Hospital Regional Materno Infantil, Secretaria de Salud, Gobierno del Estado de Nuevo León, Avenida San Rafael 450, Colonia San Rafael, CP 67140, Ciudad Guadalupe, Nuevo León, México
| | - G Sánchez-Ferrer
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Avenida Ignacio Morones Prieto 3000 poniente, Colonia Doctores, CP 64710, Monterrey, Nuevo León, México
| | - H Flores-Mendoza
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Avenida Ignacio Morones Prieto 3000 poniente, Colonia Doctores, CP 64710, Monterrey, Nuevo León, México
| | - F Castorena-Torres
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Avenida Ignacio Morones Prieto 3000 poniente, Colonia Doctores, CP 64710, Monterrey, Nuevo León, México
| | - M A Aguilar-Torres
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Avenida Ignacio Morones Prieto 3000 poniente, Colonia Doctores, CP 64710, Monterrey, Nuevo León, México
| | - C M Sepúlveda-Treviño
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Avenida Ignacio Morones Prieto 3000 poniente, Colonia Doctores, CP 64710, Monterrey, Nuevo León, México
| | - J A Hernández-Hernández
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Avenida Ignacio Morones Prieto 3000 poniente, Colonia Doctores, CP 64710, Monterrey, Nuevo León, México
| | - R C López-Sánchez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Avenida Ignacio Morones Prieto 3000 poniente, Colonia Doctores, CP 64710, Monterrey, Nuevo León, México
| | - V J Lara-Díaz
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Avenida Ignacio Morones Prieto 3000 poniente, Colonia Doctores, CP 64710, Monterrey, Nuevo León, México.
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Perra O, Wass S, McNulty A, Sweet D, Papageorgiou K, Johnston M, Patterson A, Bilello D, Alderdice F. Training attention control of very preterm infants: protocol for a feasibility study of the Attention Control Training (ACT). Pilot Feasibility Stud 2020; 6:17. [PMID: 32055404 PMCID: PMC7008548 DOI: 10.1186/s40814-020-0556-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 01/27/2020] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Children born preterm may display cognitive, learning, and behaviour difficulties as they grow up. In particular, very premature birth (gestation age between 28 and less than 32 weeks) may put infants at increased risk of intellectual deficits and attention deficit disorder. Evidence suggests that the basis of these problems may lie in difficulties in the development of executive functions. One of the earliest executive functions to emerge around 1 year of age is the ability to control attention. An eye-tracking-based cognitive training programme to support this emerging ability, the Attention Control Training (ACT), has been developed and tested with typically developing infants. The aim of this study is to investigate the feasibility of using the ACT with healthy very preterm (VP) infants when they are 12 months of age (corrected age). The ACT has the potential to address the need for supporting emerging cognitive abilities of VP infants with an early intervention, which may capitalise on infants' neural plasticity. METHODS/DESIGN The feasibility study is designed to investigate whether it is possible to recruit and retain VP infants and their families in a randomised trial that compares attention and social attention of trained infants against those that are exposed to a control procedure. Feasibility issues include the referral/recruitment pathway, attendance, and engagement with testing and training sessions, completion of tasks, retention in the study, acceptability of outcome measures, quality of data collected (particularly, eye-tracking data). The results of the study will inform the development of a larger randomised trial. DISCUSSION Several lines of evidence emphasise the need to support emerging cognitive and learning abilities of preterm infants using early interventions. However, early interventions with preterm infants, and particularly very preterm ones, face difficulties in recruiting and retaining participants. These problems are also augmented by the health vulnerability of this population. This feasibility study will provide the basis for informing the implementation of an early cognitive intervention for very preterm infants. TRIAL REGISTRATION Registered Registration ID: NCT03896490. Retrospectively registered at Clinical Trials Protocol Registration and Results System (clinicaltrials.gov).
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Affiliation(s)
- Oliver Perra
- School of Nursing and Midwifery, Queen’s University Belfast, Medical Biology Building, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland, UK
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Sam Wass
- School of Psychology, University of East London, London, UK
| | - Alison McNulty
- TinyLife, The Premature Baby Charity for Northern Ireland, Belfast, UK
| | - David Sweet
- Health and Social Care Belfast Trust, Belfast, Northern Ireland, UK
| | - Kostas Papageorgiou
- School of Psychology, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Matthew Johnston
- School of Nursing and Midwifery, Queen’s University Belfast, Medical Biology Building, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland, UK
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, Northern Ireland, UK
- School of Psychology, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Aaron Patterson
- School of Psychology, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Delfina Bilello
- School of Nursing and Midwifery, Queen’s University Belfast, Medical Biology Building, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland, UK
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, Northern Ireland, UK
- School of Psychology, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Fiona Alderdice
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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15
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Costa R, Franco C, Santos N, Maio P, Vieira F, Antunes S, Martins L, Tuna ML. [Metabolic Bone Disease of Prematurity in Very Low Birthweight Infants: Retrospective Observational Study]. ACTA MEDICA PORT 2019; 32:536-541. [PMID: 31445534 DOI: 10.20344/amp.10994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 04/05/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Metabolic bone disease of prematurity consists in a decrease of bone matrix mineral content, in comparison with the level expected for gestational age. Screening of this condition is based on serum alkaline phosphatase and phosphate levels. The aim of this study is to evaluate the prevalence of metabolic bone disease of prematurity, to assess the aspects associated with a higher risk of this disease and to describe the growth of newborns with birth weight below 1500 g and metabolic bone disease of prematurity. MATERIAL AND METHODS Observational, retrospective, multicenter and descriptive study in three neonatal intensive care units in Portugal, from May 1st 2016 to April 30th 2017. A convenience sample of very low birthweight newborns was obtained. Demographic, clinical, and laboratory variables were described in newborns with and without metabolic bone disease of prematurity. RESULTS A total of 53 newborns were included in this study: 30 males, 16 with gestational age ≤ 28 weeks. Five cases of metabolic bone disease of prematurity were diagnosed. In this group, the majority of patients was male and presented a lower gestational age and birth weight, in comparison with the group without metabolic bone disease of prematurity. The average duration of parenteral nutrition was higher in newborns with metabolic bone disease of prematurity and the calcium/phosphate ratio was lower than the recommended values. Growth was similar in both groups. No patient with metabolic bone disease of prematurity underwent physical rehabilitation. DISCUSSION The prevalence of metabolic bone disease of prematurity was 9.43%, which is lower than what is described in the literature. However, only 50% of newborns completed the screening according to the recommendations. The main risk factors identified concur with the literature. CONCLUSION Metabolic bone disease of prematurity is a frequent but underdiagnosed comorbidity in very low birthweight newborns. It is essential to screen newborns at risk for this condition, using biochemical markers, as well as structure nutritional interventions and physical stimulation in order to avoid short and long-term consequences of this disease.
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Affiliation(s)
- Raquel Costa
- Serviço de Pediatria. Hospital Espírito Santo de Évora. Évora. Portugal
| | - Catarina Franco
- Serviço de Pediatria. Hospital Divino Espírito Santo. Ponta Delgada. Portugal
| | - Nádia Santos
- Serviço de Pediatria. Hospital Espírito Santo de Évora. Évora. Portugal
| | - Patrícia Maio
- Serviço de Pediatria. Hospital Espírito Santo de Évora. Évora. Portugal
| | - Filipa Vieira
- Serviço de Pediatria. Hospital São Francisco Xavier. Centro Hospitalar Lisboa Ocidental. Lisboa. Portugal
| | - Sónia Antunes
- Serviço de Neonatologia. Hospital Espírito Santo de Évora. Évora. Portugal
| | - Laura Martins
- Serviço de Neonatologia. Hospital Espírito Santo de Évora. Évora. Portugal
| | - Madalena Lopo Tuna
- Serviço de Neonatologia. Hospital São Francisco Xavier. Centro Hospitalar Lisboa Ocidental. Lisboa. Portugal
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Bae CW, Kim CY, Chung SH, Choi YS. History of Pulmonary Surfactant Replacement Therapy for Neonatal Respiratory Distress Syndrome in Korea. J Korean Med Sci 2019; 34:e175. [PMID: 31243934 PMCID: PMC6597488 DOI: 10.3346/jkms.2019.34.e175] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/07/2019] [Indexed: 11/21/2022] Open
Abstract
Neonatal respiratory distress syndrome (RDS) is a disease that is unique to newborn infants. It is caused by a deficiency of pulmonary surfactant (PS), which is usually ready to be activated around the perinatal period. Until RDS was more clearly understood, it was not known why premature infants died from respiratory failure, although pathology revealed hyaline membranes in the alveoli. Surprisingly, the era of PS replacement therapy began only relatively recently. The first clinical trial investigating neonatal RDS was conducted in 1980. Since then, newborn survival has improved dramatically, which has led to significant advances in the field of neonatology. The present comprehensive review addresses PS, from its discovery to the application of artificial PS in newborns with RDS. It also reviews the history of PS in Korea, including its introduction, various commercial products, present and past research, newborn registries, and health insurance issues. Finally, it describes the inception of the Korean Society of Neonatology and future directions of research and treatment.
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Affiliation(s)
- Chong Woo Bae
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Chae Young Kim
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Hoon Chung
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea.
| | - Yong Sung Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
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Marques B, Martins R, Rodrigues T, Oliveira G, Abrantes M. Performance of Intergrowth 21st Growth Charts in the Diagnosis of Small and Large for Gestational Age in Term and Preterm Newborns. ACTA MEDICA PORT 2019; 33:15-21. [PMID: 31738706 DOI: 10.20344/amp.10990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 06/16/2019] [Accepted: 06/17/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Birth weight is a major contributor to neonatal morbidity and mortality and is associated with chronic diseases in adulthood. This study aimed to evaluate the use of Intergrowth 21st instead of the Fenton & Kim 2013 growth charts in the diagnosis of small and large for gestational age in a group of Portuguese newborns. MATERIAL AND METHODS We conducted an analytical and retrospective study to evaluate birth weight of term and preterm newborns using both growth charts. Groups studied: 'Term-weeks' and 'Term-days' (term newborns with gestational age in weeks and days, respectively), 'Preterm-weeks' and 'Preterm-days' (preterm newborns with gestational age in weeks and days, respectively). RESULTS A total of 14 056 newborns were included, 6% preterm. Using the Intergrowth 21st growth charts, the groups 'Term-weeks' (n = 12 081), 'Term-days' (n = 1118), 'Preterm-weeks' (n = 617) and 'Preterm-days' (n = 240), classified as small for gestational age according to the Fenton & Kim 2013 growth charts were adequate for gestational age in 52.8%, 57.8%, 37.7% and 9.3% respectively; and 9.2%, 9.2%, 5.9% and 0.6% of adequate for gestational age newborns were large for gestational age, respectively. In the 'Pretermdays' group, 7.9% of adequate for gestational age newborns were small for gestational age and 22.2% of large for gestational age newborns were adequate for gestational age, all with gestational age below 231 days. DISCUSSION The use of the Intergrowth 21st growth charts in this sample resulted in a lower number of newborns being classified as small for gestational age, except in very preterm newborns. CONCLUSION Considering the results obtained, we suggest that Portuguese maternity hospitals use the Intergrowth 21st instead of the Fenton & Kim 2013 growth charts. However, more studies are needed to confirm these results.
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Affiliation(s)
- Bárbara Marques
- Neonatology Service. Department of Pediatrics. Hospital Santa Maria. Centro Hospitalar e Universitário Lisboa Norte. Centro Académico de Medicina de Lisboa. Lisboa. Portugal
| | - Rosa Martins
- Neonatology Service. Department of Pediatrics. Hospital Santa Maria. Centro Hospitalar e Universitário Lisboa Norte. Centro Académico de Medicina de Lisboa. Lisboa. Portugal
| | - Teresa Rodrigues
- Biomaths Laboratory. Faculty of Medicine. University of Lisbon. Lisbon. Portugal
| | - Graça Oliveira
- Neonatology Service. Department of Pediatrics. Hospital Santa Maria. Centro Hospitalar e Universitário Lisboa Norte. Centro Académico de Medicina de Lisboa. Lisboa. Portugal
| | - Margarida Abrantes
- Neonatology Service. Department of Pediatrics. Hospital Santa Maria. Centro Hospitalar e Universitário Lisboa Norte. Centro Académico de Medicina de Lisboa. Lisboa. Portugal
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Abstract
BACKGROUND This study was performed to determine survival and morbidity rates in very low birth weight infants (VLBWIs) in the Korean Neonatal Network (KNN), and to compare neonatal outcomes with those in other countries. METHODS Data were collected for 8,269 VLBWIs with gestational age (GA) ≥ 22 weeks who were born between January 1, 2013 and December 31, 2016, and admitted to the neonatal intensive care units of the KNN. RESULTS The survival rate of all VLBWIs and of infants with GA 22-23, 24-25, 26-27, 28-29, 30-32, and > 32 weeks were 86% (total), 33%, 65%, 84%, 94%, 97%, and 98%, respectively. The bronchopulmonary dysplasia (BPD) rates of all VLBWIs and of infants with GA 22-23, 24-25, 26-27, 28-29, 30-32, and > 32 weeks were 30% (total), 88%, 64%, 47%, 26%, 14%, and 5%, respectively. The intraventricular hemorrhage rates (≥ grade III) of all VLBWIs and of infants with GA 22-23, 24-25, 26-27, 28-29, 30-32, and > 32 weeks were 10% (total), 45%, 27%, 12%, 5%, 2%, and 1%, respectively. In an international comparison, the survival rate of VLBWIs with GA 24-27 weeks in KNN was lower, and the BPD rate of VLBWIs in the KNN was higher than that of the neonatal networks of other countries. CONCLUSION Despite overall improvements in neonatal outcomes, the survival and morbidity rates of more immature infants with GA 22-27 weeks need further improvement. Therefore, it would be necessary to develop more optimal treatment strategies and perform more active quality improvement to further improve neonatal outcomes of VLBWIs in Korea.
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Affiliation(s)
- Jang Hoon Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - O Kyu Noh
- Department of Radiation and Oncology, Ajou University School of Medicine, Suwon, Korea
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
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Ahn SY, Chang YS, Sung SI, Park WS. Mesenchymal Stem Cells for Severe Intraventricular Hemorrhage in Preterm Infants: Phase I Dose-Escalation Clinical Trial. Stem Cells Transl Med 2018; 7:847-856. [PMID: 30133179 PMCID: PMC6265626 DOI: 10.1002/sctm.17-0219] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 06/24/2018] [Indexed: 12/15/2022] Open
Abstract
We previously demonstrated that transplanting mesenchymal stem cells (MSCs) improved recovery from brain injury induced by severe intraventricular hemorrhage (IVH) in newborn rats. To assess the safety and feasibility of MSCs in preterm infants with severe IVH, we performed a phase I dose-escalation clinical trial. The first three patients received a low dose of MSCs (5 × 106 cells/kg), and the next six received a high dose (1 × 107 cells/kg). We assessed adverse outcomes, including mortality and the progress of posthemorrhagic hydrocephalus. Intraventricular transplantation of MSCs was performed in nine premature infants with mean gestational age of 26.1 ± 0.7 weeks and birth weight of 808 ± 85 g at 11.6 ± 0.9 postnatal days. Treatment with MSCs was well tolerated, and no patients showed serious adverse effects or dose-limiting toxicities attributable to MSC transplantation. There was no mortality in IVH patients receiving MSCs. Infants who underwent shunt surgery showed a higher level of interleukin (IL)-6 in cerebrospinal fluid (CSF) obtained before MSC transplantation in comparison with infants who did not receive a shunt. Levels of IL-6 and tumor necrosis factor-α in initially obtained CSF correlated significantly with baseline ventricular index. Intraventricular transplantation of allogeneic human UCB-derived MSCs into preterm infants with severe IVH is safe and feasible, and warrants a larger, and controlled, phase II study. Stem Cells Translational Medicine 2018;7:847-856.
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Affiliation(s)
- So Yoon Ahn
- Department of Pediatrics, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
- Stem Cell and Regenerative Medicine InstituteSamsung Medical CenterSeoulSouth Korea
- Department of Health Sciences and TechnologySAIHST, Sungkyunkwan UniversitySeoulSouth Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
- Stem Cell and Regenerative Medicine InstituteSamsung Medical CenterSeoulSouth Korea
- Department of Health Sciences and TechnologySAIHST, Sungkyunkwan UniversitySeoulSouth Korea
| | - Se In Sung
- Department of Pediatrics, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Won Soon Park
- Department of Pediatrics, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
- Stem Cell and Regenerative Medicine InstituteSamsung Medical CenterSeoulSouth Korea
- Department of Health Sciences and TechnologySAIHST, Sungkyunkwan UniversitySeoulSouth Korea
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20
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Silva NR, Oliveira J, Berenguer A, Graça AM, Abrantes M, Moniz C. [Morbidity in Prematurity Associated with Fetal Growth Restriction: Experience of a Tertiary Care Center]. ACTA MEDICA PORT 2018; 31:648-655. [PMID: 30521458 DOI: 10.20344/amp.9599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 09/17/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Prematurity and low birth weight have been associated with increased neonatal morbidity and mortality. This study aimed to evaluate possible risk factors for prematurity associated with fetal growth restriction and being small for gestational age and to determine the incidence of morbidity in these two groups of infants. MATERIAL AND METHODS Retrospective case-control study of newborns with gestational age of less than 32 weeks, with obstetric diagnosis of fetal growth restriction and with the clinical diagnosis of small for gestational age, admitted to the Neonatal Intensive Care Unit of a tertiary hospital for a period of six years. RESULTS A total of 356 newborns were studied, with an incidence of 11% of fetal growth restriction and 18% of small for gestational age. Pre-eclampsia was the risk factor for gestation with higher statistical significance (47% vs 16%, p < 0.001) in small for gestational age newborns. There was also a higher incidence of mild bronchopulmonary dysplasia (66% vs 38%, p = 0.005), late sepsis (59% vs 37%, p = 0.003), retinopathy of prematurity (58% vs 26%, p = 0.003) and necrotizing enterocolitis (20% vs 9%, p = 0.005). Mortality was similar in all three groups. DISCUSSION There were fewer newborn males diagnosed with fetal growth restriction during pregnancy compared to women. Significant differences were observed in the group of these infants regarding the occurrence of chorioamnionitis and pre-eclampsia in comparison to the control group. Newborns with fetal growth restriction and small for age had higher scores on clinical risk indices compared to the control group. In general, small for gestational age newborns had a higher incidence of morbidity than infants with fetal growth restriction and the control group. CONCLUSION Advances in neonatal intensive care decreased mortality in preterm infants. However, there are still significant differences in the incidence of morbidity in newborns with growth compromise. The collaboration between obstetricians and neonatologists provides the basis for a correct clinical evaluation, early signaling and global intervention on these newborns, with a significant impact on short and long-term prognosis.
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Affiliation(s)
| | - Joana Oliveira
- Serviço de Pediatria. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal
| | - Alberto Berenguer
- Serviço de Neonatologia. Departamento de Pediatria. Hospital Universitário de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Clínica Universitária de Pediatria. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - André M Graça
- Serviço de Neonatologia. Departamento de Pediatria. Hospital Universitário de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Clínica Universitária de Pediatria. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Margarida Abrantes
- Serviço de Neonatologia. Departamento de Pediatria. Hospital Universitário de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Clínica Universitária de Pediatria. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Carlos Moniz
- Serviço de Neonatologia. Departamento de Pediatria. Hospital Universitário de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Clínica Universitária de Pediatria. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
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Abstract
Objective To describe a form of tooth pigmentation caused by serum bilirubin deposition during dental calcification in a premature child. The bilirubin levels during the three months after birth are presented. In this period the crowns of the primary teeth are still forming. Such anomaly does not have symptoms, but has a displeasing effect and great anxiety within the family. Case report The case reported here highlights the relevance of past medical history, especially the diagnoses of prolonged conjugated hyperbilirubinemia, in this case, to confirm them and to comfort the family. In this case, no esthetic treatment had been undertaken because the child was still too young and not yet concerned. The dental treatment plan included regular checkups every 3 months for maintaining oral health to prevent caries. Conclusion As this is a rare condition that affects the teeth, parents will most likely look for a dentist for treatment. Therefore, dentists must be aware or such abnormalities and take a multidisciplinary approach, thus making it possible to establish a final diagnosis.
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Affiliation(s)
- Gabriel S Barbério
- Department of Pediatric Dentistry, Bauru School of Dentistry, University of Sao Paulo, Bauru, Brazil
| | - Ana C G Zingra
- Department of Pediatric Dentistry, Bauru School of Dentistry, University of Sao Paulo, Bauru, Brazil
| | - Paulo S S Santos
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of Sao Paulo, Bauru, Brazil
| | - Maria A A M Machado
- Department of Pediatric Dentistry, Bauru School of Dentistry, University of Sao Paulo, Bauru, Brazil
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Hwang J, Kim YS, Shin JH, Choi BM. Hemodynamic Effects on Systemic Blood Flow and Ductal Shunting Flow after Loading Dose of Intravenous Caffeine in Preterm Infants according to the Patency of Ductus Arteriosus. J Korean Med Sci 2018; 33:e25. [PMID: 29318792 PMCID: PMC5760810 DOI: 10.3346/jkms.2018.33.e25] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/14/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In preterm infants, caffeine citrate is used to stimulate breathing before they are weaned from mechanical ventilation and to reduce the frequency of apnea. In recent studies, effects of caffeine on the cardiovascular system have been emphasized in preterm infants with patent ductus arteriosus (PDA). METHODS This study aimed to assess the short-term hemodynamic effects on systemic blood flow and ductal shunting flow after loading standard doses of intravenous caffeine in preterm infants. Echocardiographic studies were performed by a single investigator, before and at 1 hour and 4 hours after an intravenous infusion of a loading dose as 20 mg/kg caffeine citrate for 30 minutes. RESULTS In 25 preterm infants with PDA, left ventricular output decreased progressively during 4 hours after caffeine loading. Superior vena cava (SVC) flow decreased and ductal shunting flow increased at 1 hour and then recovered at 4-hour to baseline values. A diameter of PDA significantly decreased only at 4-hour after caffeine loading. There were no significant changes of these hemodynamic parameters in 29 preterm infants without PDA. CONCLUSION In preterm infants with PDA, a standard intravenous loading dose of 20 mg/kg caffeine citrate was associated with increasing ductal shunting flow and decreasing SVC flow (as a surrogate for systemic blood flow) 1 hour after caffeine loading, however, these hemodynamic parameters recovered at 4 hours according to partial constriction of the ductus arteriosus. Close monitoring of hemodynamic changes would be needed to observe the risk for pulmonary over-circulation or systemic hypo-perfusion due to transient increasing ductal shunting flow during caffeine loading in preterm infants with PDA.
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Affiliation(s)
- Jihye Hwang
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Yu Seon Kim
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Jeong Hee Shin
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Byung Min Choi
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea.
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23
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Valizadeh L, Mahallei M, Safaiyan A, Ghorbani F, Peyghami M. Comparison of the Effect of Plastic Cover and Blanket on Body Temperature of Preterm Infants Hospitalized in NICU: Randomized Clinical Trial. J Caring Sci 2017; 6:163-172. [PMID: 28680870 PMCID: PMC5488671 DOI: 10.15171/jcs.2017.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/11/2016] [Indexed: 11/21/2022] Open
Abstract
Introduction: Preterm infants are unable to regulate their
body temperature and there are insufficient research evidences on different kinds of
covers for hospitalized preterm infants; therefore, the present study was conducted with
the aim of comparing the effects of plastic and blanket covers on the body temperature of
preterm infants under radiant warmer. Methods: This randomized cross-over clinical trial was
carried out upon 80 infants with the gestational age of 28-30 weeks and birth weight of
800- 1250 gr who were in Neonatal Intensive Care Unit on the second day of their
hospitalization. The study lasted for two days. In group 1, the plastic cover was used
during the first day of the study while the blankets were used during the second day.
Infants’ heads were kept out of the cover and coated with a hat. In group 2, the plastic
cover was used during the first day of the study while the blanket was used during second
day. Digital thermometer was used to measure infants’ axillary temperature. The data was
analyzed using SPSS ver 13 and MiniTab software. Descriptive statistics, (Mean (SE),
95%CI) and inferential statistics (Repeated measurement and ANCOVA tests) were used. Results: The mean body temperature of the infants in the
group covered with the plastic was calculated to be higher and the warmer was set on low
temperature. Conclusion: Using plastic cover during the first few days of
hospitalization in NICU resulted in regulation of preterm infants’ body temperature.
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Affiliation(s)
- Leila Valizadeh
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid Mahallei
- Department of Pediatrics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdolrasoul Safaiyan
- Department of Biostatistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Ghorbani
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Peyghami
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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24
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Nichani V, Dirks K, Burns B, Bird A, Morton S, Grant C. Green space and pregnancy outcomes: Evidence from Growing Up in New Zealand. Health Place 2017; 46:21-28. [PMID: 28463707 DOI: 10.1016/j.healthplace.2017.04.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 04/15/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To determine whether maternal exposure to green space during pregnancy is associated with birth weight and gestational age, and whether these associations are modified by demographic and residential factors. METHODS Data describing 5091 mother-newborn pairs with residential address during pregnancy linked to data describing their green space exposure. Independent associations determined using linear mixed effects models. RESULTS Maternal exposure to green space during pregnancy was not associated with birth weight and gestational age for the entire cohort. For pregnant women who have not acquired secondary school education, increased exposure to green space was associated with increased gestational age. CONCLUSION The provision of green space might prove to be beneficial in terms of increasing gestational age for pregnant women who have not acquired secondary school education qualifications.
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Affiliation(s)
- Vikram Nichani
- Section of Epidemiology and Statistics, School of Population Health, University of Auckland, Auckland, New Zealand.
| | - Kim Dirks
- Section of Epidemiology and Statistics, School of Population Health, University of Auckland, Auckland, New Zealand.
| | - Bruce Burns
- School of Biological Sciences, University of Auckland, Auckland, New Zealand.
| | - Amy Bird
- Centre for Longitudinal Research he Ara ki Mua, School of Population Health, University of Auckland, Auckland, New Zealand.
| | - Susan Morton
- Centre for Longitudinal Research he Ara ki Mua, School of Population Health, University of Auckland, Auckland, New Zealand.
| | - Cameron Grant
- Centre for Longitudinal Research he Ara ki Mua, School of Population Health, University of Auckland, Auckland, New Zealand; Department of Pediatrics, Child and Youth Health, School of Medicine, University of Auckland, Auckland, New Zealand; General Pediatrics, Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand.
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25
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Perez GF, Pérez-Losada M, Isaza N, Rose MC, Colberg-Poley AM, Nino G. Nasopharyngeal microbiome in premature infants and stability during rhinovirus infection. J Investig Med 2017; 65:984-990. [PMID: 28363939 DOI: 10.1136/jim-2017-000414] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 12/21/2022]
Abstract
RATIONALE The nasopharyngeal (NP) microbiota of newborns and infants plays a key role in modulating airway inflammation and respiratory symptoms during viral infections. Premature (PM) birth modifies the early NP environment and is a major risk factor for severe viral respiratory infections. However, it is currently unknown if the NP microbiota of PM infants is altered relative to full-term (FT) individuals. OBJECTIVES To characterize the NP microbiota differences in preterm and FT infants during rhinovirus (RV) infection. METHODS We determined the NP microbiota of infants 6 months to ≤2 years of age born FT (n=6) or severely PM<32 weeks gestation (n=7). We compared microbiota composition in healthy NP samples and performed a longitudinal analysis during naturally occurring RV infections to contrast the microbiota dynamics in PM versus FT infants. RESULTS We observed significant differences in the NP bacterial community of PM versus FT. NP from PM infants had higher within-group dissimilarity (heterogeneity) relative to FT infants. Bacterial composition of NP samples from PM infants showed increased Proteobacteria and decreased in Firmicutes. There were also differences in the major taxonomic groups identified, including Streptococcus, Moraxella, and Haemophilus. Longitudinal data showed that these prematurity-related microbiota features persisted during RV infection. CONCLUSIONS PM is associated with NP microbiota changes beyond the neonatal stage. PM infants have an NP microbiota with high heterogeneity relative to FT infants. These prematurity-related microbiota features persisted during RV infection, suggesting that the NP microbiota of PM may play an important role in modulating airway inflammatory and immune responses in this vulnerable group.
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Affiliation(s)
- Geovanny F Perez
- Division of Pulmonary and Sleep Medicine, Children's National Health System, Washington, DC, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Department of Integrative Systems Biology, George Washington University, Washington, DC, USA.,Center for Genetic Medicine Research, Children's National Health System, Washington, DC, USA
| | - Marcos Pérez-Losada
- Center for Genetic Medicine Research, Children's National Health System, Washington, DC, USA.,Computational Biology Institute, George Washington University, Ashburn, Virginia, USA.,CIBIO-InBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, Universidade do Porto, Campus Agrário de Vairão, Vairão, Portugal
| | - Natalia Isaza
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Division of Neonatology, Children's National Medical Center, Washington, DC, USA
| | - Mary C Rose
- Division of Pulmonary and Sleep Medicine, Children's National Health System, Washington, DC, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Department of Integrative Systems Biology, George Washington University, Washington, DC, USA.,Center for Genetic Medicine Research, Children's National Health System, Washington, DC, USA.,Department of Biochemistry and Molecular Medicine, George Washington University, Washington, DC, USA
| | - Anamaris M Colberg-Poley
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Department of Integrative Systems Biology, George Washington University, Washington, DC, USA.,Center for Genetic Medicine Research, Children's National Health System, Washington, DC, USA.,Department of Biochemistry and Molecular Medicine, George Washington University, Washington, DC, USA
| | - Gustavo Nino
- Division of Pulmonary and Sleep Medicine, Children's National Health System, Washington, DC, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Department of Integrative Systems Biology, George Washington University, Washington, DC, USA.,Center for Genetic Medicine Research, Children's National Health System, Washington, DC, USA
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26
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Jang HL, Cho JY, Kim MJ, Kim EJ, Park EY, Park SA, Kim IY, Choi YS, Bae CW, Chung SH. The Experience of Human Milk Banking for 8 Years: Korean Perspective. J Korean Med Sci 2016; 31:1775-1783. [PMID: 27709856 PMCID: PMC5056210 DOI: 10.3346/jkms.2016.31.11.1775] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/18/2016] [Indexed: 12/22/2022] Open
Abstract
Human milk banks are a solution for mothers who cannot supply their own breast milk to their sick or hospitalized infants; premature infants, in particular, are unable to receive a full volume of breast milk for numerous reasons. As of December 2015, there was only one milk bank in a university hospital in Korea. We reviewed the basic characteristics of donors and recipients, and the amounts and contamination of breast milk donated at the Human Milk Bank in Kyung Hee University Hospital at Gangdong in Korea from 2008 to 2015. The donor pool consisted of 463 first-time donors and 452 repeat donors who made 1,724 donations. A total of 10,820 L of breast milk was collected, and 9,541.6 L were processed. Detectable bacteria grew in 12.6% after pasteurization and 52.5% had cytomegalovirus DNA before pasteurization in donated milk. There were 836 infant and 25 adult recipients; among new infant recipients, 48.5% were preterm; the groups received 8,009 and 165.7 L of donor milk, respectively. There was an increase in the percentage of preterm infants among new infant recipients in 2015 (93.1%) compared to 2008 (8.5%). Based on the number of premature infants in Korea, the number of potential recipients is not likely to diminish anytime soon, despite efforts to improve the breastfeeding rate. Sustainability and quality improvement of the milk bank need long-term financial support by health authorities and a nationwide network similar to blood banking will further contribute to the progress of milk banking.
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Affiliation(s)
- Hye Lim Jang
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jung Yoon Cho
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Mi Jin Kim
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Eun Jeong Kim
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Eun Young Park
- Human Breast Milk Bank, Mother & Infant Care Center, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sung Ae Park
- Human Breast Milk Bank, Mother & Infant Care Center, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - In Young Kim
- Human Breast Milk Bank, Mother & Infant Care Center, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Yong Sung Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Chong Woo Bae
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Hoon Chung
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea.
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27
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Lee JH, Chang YS. Use of Medical Resources by Preterm Infants Born at Less than 33 Weeks' Gestation Following Discharge from the Neonatal Intensive Care Unit in Korea. J Korean Med Sci 2015; 30 Suppl 1:S95-S103. [PMID: 26566364 PMCID: PMC4641070 DOI: 10.3346/jkms.2015.30.s1.s95] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/24/2015] [Indexed: 11/20/2022] Open
Abstract
This study was aimed to provide data on the use of medical resources by preterm infants following discharge from the neonatal intensive care unit (NICU). The cohort included preterm infants (n=2,351) born at 22-32 weeks' gestation who were discharged from the NICUs of 44 Korean hospitals between April 2009 to March 2010. Mean duration of post-discharge follow-up was 425±237 days. After discharge from the NICU, 94.5% of total infants visited a pediatric outpatient clinic (11.5±9.8 mean visits), 42.9% visited a pediatric clinic for respiratory problems irregularly (4.9±6.6 mean visits), and 31.1% utilized emergency center at least once. Among all visits to the emergency center, 24.7% resulted in readmission and 50.8% of those visits were due to respiratory problems. At least one episode of readmission was required by 33.6% (788/2,346) of total infants, and 18.4% (431/2,346) of total infants were readmitted with respiratory problems at least once. Among all infants readmitted for respiratory problems, 16.2% (70/341) were diagnosed with respiratory syncytial virus infection which accounted for 30.3% of viral etiologies confirmed by laboratory testing. Infants born at <30 weeks' gestation had more frequent total readmission and respiratory readmission than those ≥30 weeks' gestation (2±1.7 vs. 1.7±1.2, P=0.009, 1.8±1.2 vs. 1.5±1.1, 0.027, respectively). Overall, use of medical resources is common, and respiratory problems are the leading cause of use of medical resources. Total readmissions and respiratory readmissions are more frequent in more immature infants.
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Affiliation(s)
- Jang Hoon Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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28
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Ahn SY, Shim SY, Sung IK. Intraventricular Hemorrhage and Post Hemorrhagic Hydrocephalus among Very-Low-Birth-Weight Infants in Korea. J Korean Med Sci 2015; 30 Suppl 1:S52-8. [PMID: 26566358 PMCID: PMC4641064 DOI: 10.3346/jkms.2015.30.s1.s52] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 09/15/2015] [Indexed: 11/20/2022] Open
Abstract
Here, we aimed to evaluate the incidence and mortality of intraventricular hemorrhage (IVH) and post-hemorrhagic hydrocephalus (PHH) among very-low-birth-weight (VLBW) infants in Korea and assess the associated factors of PHH. This cohort study used prospectively collected data from the Korean Neonatal Network (KNN). Among 2,386 VLBW infants in the KNN database born between January 2013 and June 2014, 63 infants who died without brain ultrasonography results were excluded. Maternal demographics and neonatal clinical characteristics were assessed. The overall incidence of IVH in all the VLBW infants was 42.2% (987 of 2,323), while those of IVH grade 1, 2, 3, and 4 were 25.1%, 7.0%, 4.8%, and 5.5%, respectively. The incidence and severity of IVH showed a negatively correlating trend with gestational age and birth weight. PHH developed in 0%, 3.5%, 36.1%, and 63.8% of the surviving infants with IVH grades 1, 2, 3, and 4, respectively. Overall, in the VLBW infants, the IVH-associated mortality rate was 1.0% (24/2,323). Only IVH grade severity was proven to be an associated with PHH development in infants with IVH grades 3-4. This is the first Korean national report of IVH and PHH incidences in VLBW infants. Further risk factor analyses or quality improvement studies to reduce IVH are warranted.
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Affiliation(s)
- So Yoon Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So-Yeon Shim
- Departmemt of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
| | - In Kyung Sung
- Department of Pediatrics, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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29
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Abstract
Currently, in the Republic of Korea, despite the very-low-birth rate, the birth rate and number of preterm infants are markedly increasing. Neonatal deaths and major complications mostly occur in premature infants, especially very-low-birth-weight infants (VLBWIs). VLBWIs weigh less than 1,500 g at birth and require intensive treatment in a neonatal intensive care unit (NICU). The operation of the Korean Neonatal Network (KNN) officially started on April 15, 2013, by the Korean Society of Neonatology with support from the Korea Centers for Disease Control and Prevention. The KNN is a national multicenter neonatal network based on a prospective web-based registry for VLBWIs. About 2,000 VLBWIs from 60 participating hospital NICUs are registered annually in the KNN. The KNN has built unique systems such as a web-based real-time data display on the web site and a site-visit monitoring system for data quality surveillance. The KNN should be maintained and developed further in order to generate appropriate, population-based, data-driven, health-care policies; facilitate active multicenter neonatal research, including quality improvement of neonatal care; and ultimately lead to improvement in the prognosis of high-risk newborns and subsequent reduction in health-care costs through the development of evidence-based neonatal medicine in Korea.
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Affiliation(s)
- Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun-Young Park
- Division of Cardiovascular and Rare Diseases, the Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Won Soon Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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30
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Kim SY, Choi CW, Jung E, Lee J, Lee JA, Kim H, Kim EK, Kim HS, Kim BI, Choi JH. Neonatal Morbidities Associated with Histologic Chorioamnionitis Defined Based on the Site and Extent of Inflammation in Very Low Birth Weight Infants. J Korean Med Sci 2015; 30:1476-82. [PMID: 26425046 PMCID: PMC4575938 DOI: 10.3346/jkms.2015.30.10.1476] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/01/2015] [Indexed: 11/20/2022] Open
Abstract
Conflicting results on the influences of histologic chorioamnionitis (HC) on neonatal morbidities might be partly originated from using different definition of HC. The aim of this study was to determine the relationship between HC and neonatal morbidities using definition of HC that reflects the site and extent of inflammation. This was a retrospective cohort study of 261 very low birth weight (VLBW) infants admitted at a tertiary academic center. Based on the site of inflammation, HC was categorized: any HC; amnionitis; funisitis; amnionitis+funisitis. The extent of inflammation in each site was reflected by sub-defining high grade (HG). The incidences of morbidities in infants with and without HC were compared. The bronchopulmonary dysplasia (BPD) rate was significantly higher in infants with amnionitis and the severe retinopathy of prematurity (ROP) rate was significantly higher in infants with any HC and funisitis. After adjustment for both gestational age and birth weight, the respiratory distress syndrome (RDS) rate was significantly lower in infants with all categories of HC except for HG amnionitis and HG funisitis, which are not associated with lower RDS rate. HG amnionitis was significantly associated with increased BPD rate but the association of HC with severe ROP disappeared. In conclusion, HC is significantly associated with decreased RDS and HG amnionitis with increased BPD while lacking association with other neonatal morbidities in VLBW infants. The association with HC and neonatal morbidities differs by the site and extent of chorioamnionitis.
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Affiliation(s)
- Su Yeong Kim
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Chang Won Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Euiseok Jung
- Department of Pediatrics, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Juyoung Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jin A Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Beyong Il Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Hwan Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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31
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Cho SJ, Shin J, Namgung R. Initial Resuscitation at Delivery and Short Term Neonatal Outcomes in Very-Low-Birth-Weight Infants. J Korean Med Sci 2015; 30 Suppl 1:S45-51. [PMID: 26566357 PMCID: PMC4641063 DOI: 10.3346/jkms.2015.30.s1.s45] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/30/2015] [Indexed: 11/20/2022] Open
Abstract
Survival of very-low-birth-weight infants (VLBWI) depends on professional perinatal management that begins at delivery. Korean Neonatal Network data on neonatal resuscitation management and initial care of VLBWI of less than 33 weeks gestation born from January 2013 to June 2014 were reviewed to investigate the current practice of neonatal resuscitation in Korea. Antenatal data, perinatal data, and short-term morbidities were analyzed. Out of 2,132 neonates, 91.7% needed resuscitation at birth, chest compression was performed on only 104 infants (5.4%) and epinephrine was administered to 80 infants (4.1%). Infants who received cardiac compression and/or epinephrine administration at birth (DR-CPR) were significantly more acidotic (P < 0.001) and hypothermic (P < 0.001) than those who only needed positive pressure ventilation (PPV). On logistic regression, DR-CPR resulted in greater early mortality of less than 7 days (OR, 5.64; 95% CI 3.25-9.77) increased intraventricular hemorrhage ≥ grade 3 (OR, 2.71; 95% CI 1.57-4.68), periventricular leukomalacia (OR, 2.94; 95% CI 1.72-5.01), and necrotizing enterocolitis (OR, 2.12; 95% CI 1.15-3.91) compared with those infants who needed only PPV. Meticulous and aggressive management of infants who needed DR-CPR at birth and quality improvement of the delivery room management will result in reduced morbidities and early death for the vulnerable VLBWI.
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Affiliation(s)
- Su Jin Cho
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Jeonghee Shin
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
| | - Ran Namgung
- Department of Pediatrics, College of Medicine, Yonsei University, Seoul, Korea
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Abstract
Background Recent experimental physiology data and a large, population-based observational study have changed umbilical cord clamping from a strictly time-based construct to a more complex equilibrium involving circulatory changes and the onset of respirations in the newly born infant. However, available evidence is not yet sufficient to optimize the management of umbilical cord clamping. Findings Current guidelines vary in their recommendations and lack advice for clinicians who face practical dilemmas in the delivery room. This review examines the evidence around physiological outcomes of delayed cord clamping and cord milking vs. immediate cord clamping. Gaps in the existing evidence are highlighted, including the optimal time to clamp the cord and the interventions that should be performed before clamping in infants who fail to establish spontaneous respirations or are severely asphyxiated, as well as those who breathe spontaneously. Conclusion Behavioral and technological changes informed by further research are needed to promote adoption and safe practice of physiologic cord clamping.
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Affiliation(s)
- Susan Niermeyer
- Section of Neonatology, University of Colorado School of Medicine, 13121 E. 17th Avenue, Mail Stop 8402, Aurora, CO 80045 USA
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Asadollahpour F, Yadegari F, Soleimani F, Khalesi N. The Effects of Non-Nutritive Sucking and Pre-Feeding Oral Stimulation on Time to Achieve Independent Oral Feeding for Preterm Infants. Iran J Pediatr 2015. [PMID: 26199713 PMCID: PMC4505995 DOI: 10.5812/ijp.25(3)2015.809] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: The survival rates of preterm infants has increased over the last years, but oral feeding difficulties are the most common problems encountered by them Objectives: This study aimed at comparing the effects of non-nutritive sucking (NNS) and pre-feeding oral stimulation on feeding skills, length of hospital stay and weight gain of 26-32 weeks gestational age preterm infants in NICU, to determine the more effective intervention. Patients and Methods: Thirty-two preterm infants were assigned randomly into three groups. One intervention group received pre-feeding oral stimulation program and the other received non-nutritive sucking stimulation, while the control group received a sham intervention. Gestational age of infants was calculated during 1, 4 and 8 oral feeding and discharge time from NICU. The infants’ weights were measured weekly from birth and at discharge time. Results: Mean gestational age on 8 time oral feeding per day, in 3 groups was not significant (P = 0.282). Although NNS and pre-feeding oral stimulation groups has fulfilled this criterion 7.55 and 6.07 days sooner than the control group, respectively (a result which is of great clinical and economic importance), but the difference did not reach statistical significance. Weight gaining at discharge time in NNS group was significantly higher than control and pre-feeding oral stimulation groups (P < 0.05). Conclusions: This study revealed that pre-feeding oral stimulation and NNS programs both were effective on oral feeding skills and weight gaining of the immature newborns. Yet, it seems that NNS program was more effective than pre-feeding oral stimulation on weight gaining.
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Affiliation(s)
- Faezeh Asadollahpour
- Department of Speech Therapy, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Fariba Yadegari
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
- Corresponding author: Fariba Yadegari, Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran. Tel: +98-9123388620. E-mail:
| | - Farin Soleimani
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
| | - Nasrin Khalesi
- Pediatric Department, Iran University of Medical Sciences, Tehran, IR Iran
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Abstract
BACKGROUND Necrotizing enterocolitis (NEC) and nosocomial sepsis are associated with increased morbidity and mortality in preterm infants. Through prevention of bacterial migration across the mucosa, competitive exclusion of pathogenic bacteria, and enhancing the immune responses of the host, prophylactic enteral probiotics (live microbial supplements) may play a role in reducing NEC and the associated morbidity. OBJECTIVES To compare the efficacy and safety of prophylactic enteral probiotics administration versus placebo or no treatment in the prevention of severe NEC or sepsis, or both, in preterm infants. SEARCH METHODS For this update, searches were made of MEDLINE (1966 to October 2013), EMBASE (1980 to October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2013, Issue 10), and abstracts of annual meetings of the Society for Pediatric Research (1995 to 2013). SELECTION CRITERIA Only randomized or quasi-randomized controlled trials that enrolled preterm infants < 37 weeks gestational age or < 2500 g birth weight, or both, were considered. Trials were included if they involved enteral administration of any live microbial supplement (probiotics) and measured at least one prespecified clinical outcome. DATA COLLECTION AND ANALYSIS Standard methods of The Cochrane Collaboration and its Neonatal Group were used to assess the methodologic quality of the trials and for data collection and analysis. MAIN RESULTS Twenty-four eligible trials were included. Included trials were highly variable with regard to enrolment criteria (that is birth weight and gestational age), baseline risk of NEC in the control groups, timing, dose, formulation of the probiotics, and feeding regimens. In a meta-analysis of trial data, enteral probiotics supplementation significantly reduced the incidence of severe NEC (stage II or more) (typical relative risk (RR) 0.43, 95% confidence interval (CI) 0.33 to 0.56; 20 studies, 5529 infants) and mortality (typical RR 0.65, 95% CI 0.52 to 0.81; 17 studies, 5112 infants). There was no evidence of significant reduction of nosocomial sepsis (typical RR 0.91, 95% CI 0.80 to 1.03; 19 studies, 5338 infants). The included trials reported no systemic infection with the supplemental probiotics organism. Probiotics preparations containing either lactobacillus alone or in combination with bifidobacterium were found to be effective. AUTHORS' CONCLUSIONS Enteral supplementation of probiotics prevents severe NEC and all cause mortality in preterm infants. Our updated review of available evidence strongly supports a change in practice. Head to head comparative studies are required to assess the most effective preparations, timing, and length of therapy to be utilized. PLAIN LANGUAGE SUMMARY Probiotics for prevention of necrotizing enterocolitis in preterm infants Necrotizing enterocolitis (NEC) is a serious disease that affects the bowel of premature infants in the first few weeks of life. Although the cause of NEC is not entirely known, milk feeding and bacterial growth play a role. Probiotics (dietary supplements containing potentially beneficial bacteria or yeast) have been used to prevent NEC. Our review of studies found that the use of probiotics reduces the occurrence of NEC and death in premature infants born weighing less than 1500 grams. There is insufficient data with regard to the benefits and potential adverse effects in the most at risk infants weighing less than 1000 grams at birth.
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Affiliation(s)
- Khalid AlFaleh
- Department of Pediatrics (Division of Neonatology), King Saud University, Riyadh, Saudi Arabia. ,
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Abstract
Bronchopulmonary dysplasia (BPD), a chronic lung disease affecting very premature infants, is a major cause of mortality and long-term morbidities despite of current progress in neonatal intensive care medicine. Though there has not been any effective treatment or preventive strategy for BPD, recent stem cell research seems to support the assumption that stem cell therapy could be a promising and novel therapeutic modality for attenuating BPD severity. This review summarizes the recent advances in stem cell research for treating BPD. In particular, we focused on the preclinical data about stem cell transplantation to improve the lung injury using animal models of neonatal BPD. These translational research provided the data related with the safety issue, optimal type of stem cells, optimal timing, route, and dose of cell transplantation, and potency marker of cells as a therapeutic agent. Those are essential subjects for the approval and clinical translation. In addition, the successful phase I clinical trial results of stem cell therapies for BPD are also discussed.
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Affiliation(s)
- So Yoon Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Soon Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kwun Y, Park HW, Kim MJ, Lee BS, Kim EAR. Validity of the ages and stages questionnaires in Korean compared to Bayley Scales of infant development-II for screening preterm infants at corrected age of 18-24 months for neurodevelopmental delay. J Korean Med Sci 2015; 30:450-5. [PMID: 25829813 PMCID: PMC4366966 DOI: 10.3346/jkms.2015.30.4.450] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 12/03/2014] [Indexed: 01/09/2023] Open
Abstract
This study aimed to evaluate the validity of the ages and stages questionnaire in Korean (ASQ 1st edition, Korean Questionnaires, Seoul Community Rehabilitation Center, 2000) for premature infants. The study population consisted of 90 premature infants born between January 1, 2005, and December 31, 2011, who were tested using the ASQ (Korean) and Bayley Scales of Infant Development (BSID) (II) at a corrected age of 18-24 months. The validity of the ASQ (Korean) using cut-off values set at < -2 SD was examined by comparing it to the BSID (II) components, namely, the mental developmental index (MDI) or psychomotor developmental index (PDI), which were both set at < 85. The calculation of the sensitivities, specificities, positive predictive values, and negative predictive values of the ASQ (Korean) components revealed that they detected infants with neurodevelopmental delay with low sensitivity and positive predictive values, however, the communication domain showed moderate correlations with MDI. The failure in more than one domain of the ASQ (Korean) was significantly correlated with the failure in MDI. The ASQ (Korean) showed low validity for screening neurodevelopmentally delayed premature infants.
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Affiliation(s)
- Yoojin Kwun
- Division of Neonatology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye Won Park
- Department of Child and Family Welfare, University of Ulsan, Ulsan, Korea
| | - Min-ju Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center Clinical Research Center, Seoul, Korea
| | - Byong Sop Lee
- Division of Neonatology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Ellen Ai-Rhan Kim
- Division of Neonatology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
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Reynolds V, Meldrum S, Simmer K, Vijayasekaran S, French N. Laryngeal pathology at school age following very preterm birth. Int J Pediatr Otorhinolaryngol 2015; 79:398-404. [PMID: 25613933 DOI: 10.1016/j.ijporl.2014.12.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 12/23/2014] [Accepted: 12/25/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Intubation injury resulting in laryngeal pathology is recognised as a possible complication of preterm birth, yet few published studies have examined such pathology and its relation to voice outcomes. This study reports on the results of prospective laryngeal function examinations of a cohort of very preterm children, all of whom presented with significant dysphonia at school age. MATERIALS AND METHODS The laryngeal pathology of 20 very preterm children, born between 23 and 29 weeks gestation, was examined under halogen and stroboscopic conditions. Laryngeal structure and function were assessed using a rigid laryngoscope or a flexible nasendoscope. The approach was selected based on the age and/or likely compliance of the child. RESULTS Nineteen children were found to have structural laryngeal pathology. Fourteen children presented with a chink to the posterior glottis and all demonstrated at least a mild degree of supraglottic hyperfunction. Other common findings were arytenoid prolapse and vocal fold immobility. More isolated findings included posterior scar band, vocal fold atrophy, arytenoid oedema and growth on the vocal folds. One child who presented with structural laryngeal pathology was never intubated. DISCUSSION Supraglottic hyperfunction was common to all participants, regardless of the nature and extent of underlying structural laryngeal pathology. Posterior glottic chink was the most common pattern of incomplete vocal fold closure. These data support the hypothesis that very preterm children adopt supraglottic tightening to compensate for underlying laryngeal pathology. The mechanism underlying laryngeal damage in the child who was not intubated is unclear. CONCLUSIONS Voice quality of very preterm children is affected by both laryngeal structure and function. A trial of behavioural voice treatment is recommended to evaluate any therapeutic response in this population.
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Affiliation(s)
- Victoria Reynolds
- School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia.
| | - Suzanne Meldrum
- School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia; School of Psychology and Speech Pathology, Faculty of Health, Engineering and Science, Edith Cowan University, Perth, WA, Australia
| | - Karen Simmer
- School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia; Department of Neonatal Paediatrics, King Edward Memorial Hospital and Princess Margaret Hospital for Children, Subiaco, WA, Australia
| | - Shyan Vijayasekaran
- School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia; Department of Otolaryngology and Head and Neck Surgery, Princess Margaret Hospital for Children, Subiaco, WA, Australia; School of Surgery, University of Western Australia, Perth, WA, Australia
| | - Noel French
- Department of Neonatal Paediatrics, King Edward Memorial Hospital and Princess Margaret Hospital for Children, Subiaco, WA, Australia; State Child Development Centre, Health Department of Western Australia, Perth, WA, Australia
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Lee HJ, Lee BS, Do HJ, Oh SH, Choi YS, Chung SH, Kim EAR, Kim KS. Early sodium and fluid intake and severe intraventricular hemorrhage in extremely low birth weight infants. J Korean Med Sci 2015; 30:283-9. [PMID: 25729251 PMCID: PMC4330483 DOI: 10.3346/jkms.2015.30.3.283] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/24/2014] [Indexed: 12/03/2022] Open
Abstract
Hypernatremic dehydration is an important cause of intracranial hemorrhage. A possible association of intraventricular hemorrhage (IVH) with hypernatremia and/or high sodium intake has been suggested in preterm infants. To investigate the associations of early fluid and sodium intake or serum sodium concentrations with severe intraventricular hemorrhage (IVH) in extremely low birth weight (ELBW) infants, we reviewed the medical records of 169 inborn ELBW infants. Daily fluid and sodium intake, urine output, weight loss and serum sodium concentration during the first 4 days of life were obtained. Patients were divided into the severe IVH (grade 3/4) and the control (no or grade 1/2 IVH) group. The maximum serum sodium concentration and the incidence of hypernatremia did not differ between the two groups. Related to the fluid balance and sodium intake, the risk for severe IVH was strongly associated with total fluid and sodium intake during the initial four days of life. With respect to the fluids other than transfusion, severe IVH can be discriminated only by sodium intake but not by fluid intake. Large randomized controlled trials are required to clarify the causal relationship between the early sodium intake and severe IVH in ELBW infants.
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Affiliation(s)
- Hye Jin Lee
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Byong Sop Lee
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyun-Jeong Do
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seong-Hee Oh
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yong-Sung Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung-Hoon Chung
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Ellen Ai-Rhan Kim
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ki-Soo Kim
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Noriega-Alvarez R, Iglesias-Leboreiro J, Bernardez-Zapata I. [Premature twins: clinic comparison, reproductive assisted techniques versus spontaneous conception]. Rev Med Inst Mex Seguro Soc 2014; 52:544-549. [PMID: 25301130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Twin pregnancies occur one out of every 800. Due to the increase in maternal age and infertility, the use of assisted reproductive technology (ART) has risen. Thirty five percent of pregnancies solved using ART are twin pregnancies. A RT consists of infertility treatments in which oocytes and sperm are manipulated. The objective of this study was to compare the clinical behavior of premature twins born through ART versus those born after spontaneous conception (SC). METHODS Retrolective cohort study. The data was obtained from the records of preterm twins born between August 2010 and August 2013. Preterm twins were categorized in two groups: the ones conceived using ART versus those conceived through SC. Demographic characteristics and neonatal outcomes were compared. RESULTS The total was of 398 patients: 208 conceived in consequence of ART and 190 through SC. The primary outcome and neonatal morbidities showed no significant difference, only the incidence of necrotizing enterocolitis and the use of parenteral nutrition showed significant difference. The length of hospital stay between groups was similar. CONCLUSIONS In our population of preterm twins, the mode of conception had no detectable effect on mortality or short term morbidities.
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Affiliation(s)
- Roxana Noriega-Alvarez
- Servicio de Neonatología, División de Pediatría, Hospital Español de México, Distrito Federal, México.
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Okwundu CI, Okoromah CAN, Shah PS. Cochrane Review: Prophylactic phototherapy for preventing jaundice in preterm or low birth weight infants. ACTA ACUST UNITED AC 2014; 8:204-49. [PMID: 23878128 DOI: 10.1002/ebch.1898] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Low birth weight and premature infants are at major risk for exaggerated hyperbilirubinaemia and jaundice that can lead to bilirubin encephalopathy. Phototherapy is the most common treatment for neonatal hyperbilirubinaemia and could be most effective in preventing the sequelae of hyperbilirubinaemia if initiated prophylactically. OBJECTIVES To evaluate the efficacy and safety of prophylactic phototherapy for preterm (< 37 weeks gestational age) or low birth weight infants (birth weight < 2500 g). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3) on 31 March 2011, MEDLINE (1950 to 31 March 2011), EMBASE (1980 to 31 March 2011) and CINAHL (1982 to 31 March 2011). SELECTION CRITERIA Randomised controlled trials or quasi-randomised controlled studies evaluating the effects of prophylactic phototherapy for preterm or low birth weight infants. DATA COLLECTION AND ANALYSIS Two authors independently obtained data from published articles. We performed fixed-effect meta-analysis for the outcomes: rate of exchange transfusion, cerebral palsy or other neurodevelopmental impairment, peak serum bilirubin level and all-cause mortality. MAIN RESULTS Nine studies of 3449 participants were included. The rate of exchange transfusion was reduced in one study with liberal transfusion criteria (risk ratio (RR) 0.20; 95% confidence interval (CI) 0.13 to 0.31) but not in the other two more recent studies with stringent criteria (typical RR 0.66; 95% CI 0.19 to 2.28). There was no statistically significant difference in the rate of cerebral palsy (typical RR 0.96; 95% CI 0.50 to 1.85; two studies, 756 participants). However, one large study that reported on neurodevelopmental impairment (a composite outcome including cerebral palsy) found a slightly lower rate of neurodevelopmental impairment with prophylactic phototherapy (RR 0.85; 95% CI 0.74 to 0.99; 1804 participants). The prophylactic phototherapy group had lower peak bilirubin levels (mean difference (MD) -2.73; 95% CI -2.89 to -2.57; six studies, 2319 participants) and had fewer neonates with peak unconjugated serum bilirubin levels > 10 mg/dl (typical RR 0.27; 95% CI 0.22 to 0.33; three studies, 1090 participants) or peak unconjugated serum bilirubin levels > 15 mg/dl (typical RR 0.13; 95% CI 0.07 to 0.23; four studies, 1116 participants). There was no statistically significant difference in the rate of all-cause mortality between the two groups (typical RR 1.08; 95% CI 0.93 to 1.26; four studies, 3044 participants). AUTHORS' CONCLUSIONS Prophylactic phototherapy helps to maintain a lower serum bilirubin concentration and may have an effect on the rate of exchange transfusion and the risk of neurodevelopmental impairment. However, further well-designed studies are needed to determine the efficacy and safety of prophylactic phototherapy on long-term outcomes including neurodevelopmental outcomes.
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Affiliation(s)
- Charles I Okwundu
- Faculty of Health Sciences, University of Stellenbosch, Cape Town, South Africa.
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Ghorbani M, Dolatian M, Shams J, Alavi-Majd H. Anxiety, post-traumatic stress disorder and social supports among parents of premature and full-term infants. Iran Red Crescent Med J 2014; 16:e13461. [PMID: 24829766 PMCID: PMC4005428 DOI: 10.5812/ircmj.13461] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/10/2013] [Accepted: 08/24/2013] [Indexed: 01/04/2023]
Abstract
BACKGROUND Premature birth is one of the most important unresolved reproductive health problems. Premature birth is often traumatic and a source of distress for parents. Increased parental stress during the first year of their infant's life is a risk factor for later behavioral problems in infants. OBJECTIVES This study was designed to compare anxiety, post-traumatic stress, and social supports in parents of premature and mature infants. PATIENTS AND METHODS This was a comparative descriptive study conducted at healthcare centers of Qom city, in 2012. In this study, 82 couples (164 parents) divided into two groups including parents who have preterm and term infants. Questionnaires including items such as demographic characteristics, obstetric and post-traumatic stress disorders, Spielberger anxiety and Multidimensional Scale of Perceived Social Support were completed two months after childbirth. Data were analyzed using χ2 test, Fisher's exact test, Mann-Whitney test, independent t-test, and regression logistic using SPSS18 software. RESULTS The levels of anxiety was not significantly different in mothers and fathers in the two groups, but the trait anxiety level of mothers (P < 0.001) and fathers who had preterm infants (P = 0.01) was significantly greater than the parents of full-term infants. Post-traumatic stress disorder was significantly greater in mothers of preterm infants than those of term infants (P = 0.03), but this amount was not significantly different between the two groups of fathers. Mothers' social support did not differ significantly (P = 0.08), however, it was significantly different in fathers (P = 0.01). CONCLUSIONS Premature infants' parents are more at risk of mental disorders than term infants' parents. This result shows the need of interventions, so these parents can better deal with the problems of premature infants.
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Affiliation(s)
- Maryam Ghorbani
- Department of Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mahrokh Dolatian
- Department of Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Mahrokh Dolatian, Department of Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188202512, Fax: +98-2188202512, E-mail:
| | - Jamal Shams
- Department of Psychiatry, Behavioral Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Hamid Alavi-Majd
- Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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Kong M, Shin DH, Kim SJ, Ham DI, Kang SW, Chang YS, Park WS. Retinopathy of prematurity in infants born before 25 weeks gestation in a Korean single neonatal intensive care unit: incidence, natural history and risk factors. J Korean Med Sci 2012; 27:1556-62. [PMID: 23255858 PMCID: PMC3524438 DOI: 10.3346/jkms.2012.27.12.1556] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 10/11/2012] [Indexed: 11/23/2022] Open
Abstract
As younger preterm infants are able to survive, more extremely preterm infants are at risk of developing retinopathy of prematurity (ROP). To investigate the incidence, progression and risk factors of ROP in extremely preterm infants in Korea, the medical records of infants born before 25 weeks gestation were retrospectively reviewed. The criteria for laser treatment agreed with type 1 ROP as defined by the Early Treatment for Retinopathy of Prematurity study. Of the 121 infants included in the analysis, 119 (98.4%) infants developed any stage ROP, including 78 infants (64.5%) with type 1 ROP. The mean postmenstrual age (PMA) at the onset of any ROP and type 1 ROP were 33.5 and 36.1 weeks, respectively. All but one infant developed type 1 ROP after 31 weeks PMA. Univariate analysis showed that duration of total parenteral nutrition and onset of any ROP (PMA) were associated with the development of type 1 ROP. In conclusion, this study shows high incidence of ROP in extremely preterm infants and suggests that, although current screening protocols are feasible for most preterm infants born before 25 weeks gestation, earlier screening before 31 weeks PMA may be necessary in infants with an unstable clinical course.
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Affiliation(s)
- Mingui Kong
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Hoon Shin
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Jin Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Don Il Ham
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Soon Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Hahn WH, Chang JY, Chang YS, Shim KS, Bae CW. Recent trends in neonatal mortality in very low birth weight Korean infants: in comparison with Japan and the USA. J Korean Med Sci 2011; 26:467-73. [PMID: 21468252 PMCID: PMC3069564 DOI: 10.3346/jkms.2011.26.4.467] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 02/17/2011] [Indexed: 12/01/2022] Open
Abstract
With regard to the outcome of intensive neonatal care, one of the most important concerns in neonatology is the mortality rate of very low birth weight infants (VLBWI; birth weight < 1,500 g) and extremely low birth weight infants (ELBWI; birth weight < 1,000 g). The present study was conducted to analyze and compare the mortality of VLBWI and ELBWI and neonatal care among Korean, Japanese, and American newborns. In Korea, the survival rates of VLBWI have increased significantly; they were 31.8% in the early 1960s, 65.8% in the early 1990s, 77.5% in 2002, 84.7% in 2007, and 85.7% in 2009. The survival rates of ELBWI have also increased; they were 8.2% in the early 1960s, 37.4% in the early 1990s, 56.1% in 2002, 67.7% in 2007, and 71.8% in 2009. The survival rates of VLBWI and ELBWI have significantly improved over the past 50 yr in Korea. However, the Korean survival rates of VLBWI and ELBWI are still lower than for similar groups in Japan and the USA. To achieve better outcomes that reach the level of these countries, the organization of perinatal care centers, nationwide neonatal perinatal research networks, and regionalization are needed in Korea.
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Affiliation(s)
- Won-Ho Hahn
- Department of Pediatrics, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Ji-Young Chang
- Department of Pediatrics, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kye Shik Shim
- Department of Pediatrics, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Chong-Woo Bae
- Department of Pediatrics, School of Medicine, Kyung Hee University, Seoul, Korea
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Lim JW, Lee JJ, Park CG, Sriram S, Lee KS. Birth outcomes of Koreans by birthplace of infants and their mothers, the United States versus Korea, 1995-2004. J Korean Med Sci 2010; 25:1343-51. [PMID: 20808679 PMCID: PMC2923796 DOI: 10.3346/jkms.2010.25.9.1343] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Accepted: 02/16/2010] [Indexed: 11/30/2022] Open
Abstract
The acculturation effect of immigrant women on birth outcomes varies by race. We examined birth outcomes of three groups of births for the period 1995-2004, USA births to the USA-born Korean mothers, USA births to the non-USA-born Korean mothers, and births in Korea. In singleton USA births to both Korean parents, average birth weight was 3,294 g for the USA-born Korean mothers and 3,323 g for the non-USA-born Korean mothers. However, this difference was not significant, once controlled for other maternal sociodemographic, obstetric and medical factors. Low birth weight and prematurity prevalence were not different by maternal nativity between these two singleton groups. Average birth weight of all births including multiplets in Korea was 3,270 g, compared to 3,297 g for all USA-born infants including multiplets and births either to both or one Korean parents. This difference might have reflected a significantly lower educational attainment of mothers in Korea compared to Korean mothers in the USA. Low birth weight rate was consistently lower in infants born in Korea compared to the USA-born, but this difference became less, 4.2% and 4.6% respectively by 2004. These observations suggest that in the USA acculturation effect of Korean immigrants on birth outcomes is negligible.
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Affiliation(s)
- Jae Woo Lim
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Jung Ju Lee
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Korea
| | - Chang Gi Park
- Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, USA
| | - Sudhir Sriram
- Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, USA
| | - Kwang-sun Lee
- Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, USA
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Lee JY, Kim HS, Jung E, Kim ES, Shim GH, Lee HJ, Lee JA, Choi CW, Kim EK, Kim BI, Choi JH. Risk factors for periventricular-intraventricular hemorrhage in premature infants. J Korean Med Sci 2010; 25:418-24. [PMID: 20191041 PMCID: PMC2826744 DOI: 10.3346/jkms.2010.25.3.418] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 04/20/2009] [Indexed: 01/26/2023] Open
Abstract
Periventricular-intraventricular hemorrhage (PV-IVH) is a major cause of neurological disabilities in preterm newborns. This study aimed to determine the perinatal factors associated with PV-IVH. We conducted a retrospective case-control study from preterm infants born at < or =34 weeks of gestation and admitted to Neonatal Intensive Care Units of Seoul National University Children's Hospital and Seoul National University Bundang Hospital between June 2003 and December 2007. Neonates with no cranial sonographic data or infants transferred from other centers after three days of age were excluded. Of 1,044 eligible subjects, 59 infants with PV-IVH grade 2, 3, and 4 were allocated to the case group. The control group consisted of 118 infants without PV-IVH who were matched for gestational age and birth weight to each case of PV-IVH. At the multivariate logistic regression model, metabolic acidosis (odds ratio [OR]: 6.94; 95% confidence interval [CI]: 1.12-43.23) and use of inotropes (OR: 3.70; 95% CI: 1.16-11.84) were associated with an increased risk of PV-IVH. Maternal use of antenatal corticosteroids decreases the risk of PV-IVH (OR: 0.36; 95% CI: 0.14-0.92).
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Affiliation(s)
- Ju Young Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Cho J, Yoon YH, Kim JT, Kim KH, Lim HK, Jun YH, Hong YJ, Baek WK. Patent ductus arteriosus closure in prematurities weighing less than 1 kg by subaxillary mini-thoracotomy. J Korean Med Sci 2010; 25:24-7. [PMID: 20052343 PMCID: PMC2800029 DOI: 10.3346/jkms.2010.25.1.24] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2008] [Accepted: 03/14/2009] [Indexed: 12/03/2022] Open
Abstract
The surgical closure of patent ductus arteriosus (PDA) is provided more frequently in extremely low birth weight babies who are usually deemed unsuitable for pharmacological closure. We have adopted subaxillary mini-thoracotomy in order to lessen surgical trauma in these babies; and its clinical results were analyzed. From April 2004 to August 2008, out of 50 babies at the neonatal intensive care unit who underwent the surgical closure of PDA, 22 premature babies weighing less than 1 kg at operation were included in the study. Eleven babies were males and mean gestational age was 27 weeks ranging from 23(+3) to 30(+2) weeks. Mean body weight at operation was 816 g ranging from 490 to 989 g and average age at operation was 17.9+/-11.9 days. Of them, 17 babies (72%) were ventilator dependent preoperatively, as compared with 13 out of 28 (46%) babies that weighed more than 1 kg (P<0.05). Four babies did not survive to discharge. Among 28 babies who were heavier than 1 kg, there were only one death. However, the mortality difference was not statistically significant (P=0.11). All mortalities were caused by inherent problems of prematurity and co-morbidities. Out of 17 babies who had been ventilator dependent preoperatively, 13 weaned off successfully at 17.0+/-23.9 days after the operation. The baby patients heavier than 1 kg weaned at 6.0+/-5.3 days (P=0.27). Surgical outcome of simple and less invasive subaxillary mini-thoracotomy was satisfactory; the surgery is highly recommended for ductal closure in extremely low weight premature babies.
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Affiliation(s)
- Jungsoo Cho
- Department of Thoracic and Cardiovascular Surgery, Inha University Hospital, Incheon, Korea
| | - Yong Han Yoon
- Department of Thoracic and Cardiovascular Surgery, Inha University Hospital, Incheon, Korea
| | - Joung Taek Kim
- Department of Thoracic and Cardiovascular Surgery, Inha University Hospital, Incheon, Korea
| | - Kwang Ho Kim
- Department of Thoracic and Cardiovascular Surgery, Inha University Hospital, Incheon, Korea
| | - Hyun Kyung Lim
- Department of Anesthesiology, Inha University Hospital, Incheon, Korea
| | - Yong Hoon Jun
- Department of Pediatrics, Inha University Hospital, Incheon, Korea
| | - Young Jin Hong
- Department of Pediatrics, Inha University Hospital, Incheon, Korea
| | - Wan Ki Baek
- Department of Thoracic and Cardiovascular Surgery, Inha University Hospital, Incheon, Korea
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Mukasa GK. Observations on kangaroo baby care. Mothers Child 2002; 11:7. [PMID: 12346093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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48
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Lopez Garcia R. [Premature rupture of membranes and chorioamnionitis]. Rev Latinoam Perinatol 2002; 8:33-41. [PMID: 12342687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Abstract
Literature on serum copper (Cu) and its antioxidant protein (ceruloplasmin) in the African newborn is infrequent, and more reports are evident from developed or affluent societies. We, therefore, studied longitudinally our newborns to delineate their Cu and ceruloplasmin (CLP) status. All infants were born between July 1st, 1991 and June 30th, 1992 at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria. The preterm infants (PI) (gestational age < or = 36 weeks) were divided into 2 cohorts; A, sick and B, stable; commencing with n = 30 in each group. The groups were matched in respect to gender, gestational age, birthweight, Apgar scores and socioeconomic class. Cu levels were contemporaneously also determined in 30 (M:F, 17:13) stable full-term infants (appropriate-for-dates). Cu determination was made with atomic absorption spectrophotometry and CLP according to colorimetric P-phenylenediamine assay. Sick PI (cohort A) had significantly lower mean (SD) Cu and CLP levels at birth; 0.1 (0.2) micromol/ml and 0.5 (0.8) micromol/dl vs 0.6 (0.2) micromol/ml and 12.5 (1.2) micromol/dl in stable PI (cohort B), respectively; P < 0.05. Cu level was significantly increased by 4 weeks in cohort A; P < 0.001 (n = 25) and approached levels of the stable PI (0.7 (0.3) vs 0.8 (0.2) micromol/ml). Concerning CLP, however, catch-up of levels was delayed till 8 weeks, and a triphasic pattern of linear rise in Cu (both cohorts, but more prominent in A) and CLP (cohort A) was discernible by 24 weeks. The sick PI had mean (SD) serum CLP levels of 0.5 (0.8) micromol/dl, 5.9 (1.4), 15.2 (2.6), 17.3 (2.9), 21.2 (3.8), 25.1 (4.7) and 23.7 (3.8) micromol/dl at birth, 4, 8, 12, 20, and 24 weeks, respectively and were similar from 8 weeks in cohort B. Generally, CLP paralleled serum Cu levels. Cu levels in the full-term infant (FI) were higher at birth and became similar to PI's from 12 weeks, but were overtaken by levels in PI (both cohorts) at 24 weeks. The FI's Cu was significantly elevated by 8 weeks; mean (SD), 0.81 (0.16) micromol/ml vs 1.25 (0.19) micromol/ml; P < 0.01, paired t-test. Decreased growth rate, nonpitting pedal edema, exaggerated physiological anaemia and chronic lung disease were few morbidities noted in association with very low Cu and CLP levels (n = 15). Newborns with serum Cu and CLP>0.2 micromol/ml and >2.3 micromol/dl, respectively, did not have a poor outcome. It is tempting to suggest that absent serum CLP activity may portend a poor prognosis. Our findings (number albeit small) could be taken as a preliminary normative data for further comparisons.
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Affiliation(s)
- A I Airede
- Department of Paediatrics, University of Maiduguri Teaching Hospital, Borno State, Nigeria
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Abstract
To determine the efficacy of cooking food in iron pots to prevent anemia in premature infants, a longitudinal study on iron nutritional status was conducted in preterm, healthy infants from families of low socioeconomic level between mo 4 and 12 of life. The infants were divided randomly into two groups. The study group consisted of 22 infants whose food was cooked in iron pots; the control group consisted of 23 infants whose food was cooked in aluminum pots. Supplemental iron [2 mg/(kg.d)] was recommended from 15 d to 12 mo of age for both groups. At 12 mo of age, the group fed food cooked in iron pots had significantly better hematologic values than the group fed food cooked in aluminum pots. Differences included hemoglobin (116 +/- 16 vs. 103 +/- 20 g/L, P = 0.02), hematocrit (0.35 +/- 0.04 vs. 0.31 +/- 0.05, P = 0.005), mean corpuscular volume (72.1 +/- 10.4 vs. 62.7 +/- 11.1 fL, P = 0.005), free erythrocyte protoporphyrin (0.78 +/- 0.60 vs. 1.46 +/- 0.94 mol/L, P = 0.006) and serum ferritin (median 5 vs. 0 g/L, P = 0.001). No significant differences between groups were observed in serum iron concentration, total iron-binding capacity or transferrin saturation. Iron deficiency anemia (hemoglobin </= 110 g/L) was observed in 36.4% (8 of 22) of infants in the group fed food cooked in iron pots and in 73.9% (17 of 23) of the infants fed food cooked in aluminum pots (P = 0.03). These results indicate that the iron added to food cooked in iron pots is bioavailable. However, this increased iron availability was insufficient to satisfy the high iron requirements of this group of preterm infants.
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Affiliation(s)
- E V Borigato
- Hospital for Medicine of the Locomotor System-SARAH, Brasília, 70330-150, DF, Brazil
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