Growth of Extremely Low Birth Weight Infants (ELBW) born at a Tertiary Hospital: Statural catch-up growth continues during the 3rd year of life

1. Patti J. Thureen, MD* 1. 2. *Associate Professor, Department of Pediatrics, University of Colorado Health Sciences Center, Denver, CO. After completing this article, readers should be able to: 1. Describe the possible long-term effects of suboptimal nutrition in preterm infants and critically ill term neonates. 2. Explain why the current standard for postnatal nutrition in preterm infants may not be adequate for postnatal growth. 3. List the the lower limit at which to start intravenous protein delivery in very low-birthweight infants. 4. Characterize the commonly used definition for minimal enteral nutrition. 5. List the advantages of minimal enteral nutrition compared with exclusive total parenteral nutrition for the neonate. Nutritional practices vary dramatically among neonatal intensive care units (NICUs) in the United States. In many institutions, nutrition is introduced only gradually over the first weeks of life because of concerns of nutrient intolerance by the very preterm or ill infant who is fed intravenously and the risk of necrotizing enterocolitis (NEC) in preterm infants who are fed enterally. Often this period of nutritional deficiency is accepted as inevitable in this population. However, such a strategy of cautious nutrition might lead to a period of early malnutrition from which the neonate has a prolonged recovery and may have long-term adverse consequences. In many neonates this period of early nutritional deprivation need not be inescapable. Many neonatologists will consider the early feeding strategies for the NICU population suggested in this article to be somewhat aggressive. The premise for these recommendations for extremely low-birthweight (ELBW) infants is that avoiding early malnutrition has both short- and long-term benefits for the neonate. This strategy involves initiating total parenteral nutrition (TPN) in the first hours after birth and administering it in conjunction with initially small, and then advancing, enteral feedings beginning on the first or second day of life. Use of TPN is a means to achieve rapid, maximal nutrition, and early enteral feedings are designed to prime the gut and …

IntroductionAccurate prediction of long-term neurodevelopmental outcome is currently not possible for extremely preterm (EP) and/or extremely low birth weight (ELBW) infants before their discharge home from the hospital. While most EP and/or ELBW infants have normal outcomes, some will develop a significant neurodevelopmental disability and/or delay (NDD), including cerebral palsy (CP) and/or functional impairment (FI). These outcomes may not become apparent for months or even years after discharge. Significant time and resources are spent on surveillance of EP and/or ELBW infants assessing for possible complications of their preterm birth, which is a substantial burden for the child, family, and health system.Outcome prediction before hospital discharge relies upon a combination of birth history, neonatal complications, results of neuroimaging (cranial ultrasound [CUS], and magnetic resonance imaging [MRI]), and more recently, the general movements (GMs) assessment. Neuroimaging and GMs are qualitative assessments requiring specialist training and are subject to potential bias.The addition of quantifiable measures of the quality of movement before discharge from the hospital of an EP or ELBW infant may increase the sensitivity and specificity of the prediction of long-term neurodevelopmental outcomes. Accelerometers provide a low-cost method of quantifying movement and are easily applied without moving the baby. AimsThe aims of this thesis were to;· Review the literature surrounding outcome prediction for EP and/or ELBW infants focusing on investigations and assessments suitable for use before hospital discharge.· Undertake a prospective observational study to determine in EP and/or ELBW infants if;Routine inpatient CUS performed on EP and/or ELBW infants at approximately day five of life, day 28 of life, and 36-weeks post menstrual age (PMA), predicts NDD (i.e., CP or FI).General movements (GMs) assessment in EP and/or ELBW infants at 28-, 32-, or 36- weeks PMA predicts NDD.Developmental trajectories (calculated from two or more GMs assessments before hospital discharge) in EP and/or ELBW infants predicts NDD.Quantitative measures of motor activity at 28-, 32-, or 36-weeks PMA, obtained from a movement detection system (MDS) (comprising of four wireless tri-axial accelerometers), correlate with the GMs assessments undertaken before hospital discharge.Quantitative measures of motor activity in EP and/or ELBW infants at 28-, 32-, or 36-weeks PMA, obtained from the MDS, predicts NDD.Quantitative measures of motor activity in EP and/or ELBW infants obtained from the MDS change according to PMA at the time of assessment (28-, 32-, and 36-weeks).The PMA at which quantitative measures of motor activity obtained from the MDS in EP and/or ELBW infants first correlate with GMs assessment and predicts NDD. Research design and methodologyA prospective observational cohort was used to determine the predictive value of movement parameters obtained from an MDS consisting of four wearable sensors (tri-axial accelerometers). Participants were EP and/or ELBW infants admitted to the Mater Mothers’ Hospital (MMH), Brisbane. Movement detection system and video recordings for the GMs assessments were undertaken on infants at 28-, 32-, and 36-weeks PMA depending on their initial age at enrolment, clinical condition, and age at discharge. Results of routine CUS and long-term neurodevelopmental follow-up at one and/or two-years CA were recorded.ResultsThe CUS had an overall sensitivity of 50% and a specificity of 98% in predicting CP. The GMs assessment at 36-weeks PMA had an overall sensitivity of 20% and specificity of 100% for predicting CP and a sensitivity of 14% and specificity of 100% for predicting FI. Assessing the developmental trajectory on GMs did not improve the prediction of CP or FI. The intra- and inter- scorer reliability of the GMs assessments was poor. The MDS parameters did not differ significantly when comparing measures between; infants with and without cramped synchronised (CS) movements, infants with and without a diagnosis of CP, and infants with and without a diagnosis of FI. Many MDS parameters decreased in value with increasing PMA demonstrating a significant maturation effect. ConclusionCranial ultrasound findings continue to provide clinically useful information for long-term neurodevelopmental outcome prediction. General movements assessments performed before hospital discharge had poor sensitivity for predicting CP and FI. Isolated use of quantitative measures of movement, obtained from four tri-axial accelerometers before hospital discharge, did not appear to assist with outcome prediction for EP and/or ELBW infants. The study was limited by the large number of parameters used for comparison. Future research should use adequately powered studies and investigate the use of pattern recognition and artificial intelligence in movement analysis as well as the combination of new neuroimaging techniques and other biomarkers. Surveillance and assessments post-hospital discharge remain essential for the detection of neurodevelopmental problems in infants born EP and/or ELBW.

This study aimed to evaluate whether elevated urine desmosine levels at 3 weeks of age were associated with severe radiological findings, bronchopulmonary dysplasia (BPD), and post-prematurity respiratory disease (PRD) in extremely preterm (EP) or extremely low birth weight (ELBW) infants. This study recruited 37 EP (22-27 completed weeks) or ELBW (<1,000 g) infants. Urine was collected between 21 and 28 postnatal days, and desmosine was measured using an enzyme-linked immunosorbent assay kit; the urine creatinine level was also measured. Bubbly/cystic lungs were characterized by emphysematous chest X-rays on postnatal day 28. Furthermore, provision of supplemental oxygen or positive-pressure respiratory support at 40 weeks' postmenstrual age defined BPD, and increased medical utilization at 18 months of corrected age defined PRD. The desmosine/creatinine threshold was determined by receiver operating characteristic analysis. The adjusted risk and 95% confidence interval (CI) for elevated urine desmosine/creatinine levels were estimated by logistic regression analysis. Elevated urine desmosine/creatinine levels higher than the threshold were significantly associated with bubbly/cystic lungs (8/13 [61.5%] vs. 2/24 [8.3%], p = 0.001), BPD (10/13 [76.9%] vs. 8/24 [33.3%], p = 0.02), and PRD (6/13 [46.2%] vs. 2/24 [8.3%], p = 0.01). After adjusting for gestational age, birth weight, and sex, the urine desmosine/creatinine levels were significantly higher in those who were highly at risk of bubbly/cystic lungs (odds ratio [OR], 13.2; 95% CI, 1.67-105) and PRD (OR, 13.8; 95% CI, 1.31-144). Elevated urine desmosine/creatinine levels on the third postnatal week were associated with bubbly/cystic lungs on day 28 and PRD at 18 months of corrected age in EP or ELBW infants. · Urine desmosine was prospectively measured in 3-week-old EP/ELBW infants.. · Elevated urine desmosine levels were associated with emphysematous radiological findings on day 28, PRD at 18 months of corrected age.. · Urine desmosine may be a promising biomarker indicating lung damage in EP/ELBW infants..

Early postnatal administration of intravenous amino acids to preterm, extremely low birth weight infants

Background: Very Low Birth Weight (VLBW) infants weigh &lt;1500 grams and Extremely Low Birth Weight (ELBW) infants weigh &lt;1000 grams. They are predominantly premature but may also be associated with Intrauterine Growth Restriction (IUGR). The VLBW rate is an accurate predictor of infant mortality rate.Objective: The study was aimed to find out the hospital incidence of VLBW and ELBW babies and outcome of these babies, till they were discharged from the hospital/NICU.Methods: A descriptive study was conducted among 109 cases who weighed less than 1500 grams. The babies were evaluated for mortality and various morbidities till they were discharged from the hospital. Descriptive statistics was applied using SPSS 21.0 to show antenatal profile and immediate outcome. Results: Out of 109 cases, ELBW were 30.2% and VLBW were 69.8%. Among the ELBW babies, 30.3% survived and 75% in VLBW. The mortality rate in ELBW and VLBW babies were 69.7% and 25% respectively. Among the ELBW, common morbidities were NNJ (94%), Presumed NNS (87.8%), RDS (82.6%), Hypoglycemia (56.5%), Hypothermia (26%), Birth Asphyxia (15.1%). In the VLBW group, common morbidities were Presumed NNS (86.4%), NNJ (82%), RDS (46.5%), Hypoglycemia (30.2%). The mean duration of hospital stay was 8.6 days (SD ± 3.38).Conclusions: Common immediate morbidities were NNS, RDS, Hypothermia, Anemia, Shock, CHD, Birth Asphyxia and NEC. Well trained staff in the NICU and medical facilities like availability of Surfactant therapy, more number of mechanical ventilators could improve the survival of these babies in our setting.Journal of Nepalgunj Medical College Vol.12(1) 2014: 32-34

Objective To review the trends of survival rates and complications in extremely low birth weight (ELBW) infants and to improve the prognosis of ELBW infants. Method From January 1999 to December 2015, ELBW infants in our hospital were retrospectively studied. Their survival rates and complications were compared among groups with different birth weight, and the risk factors for survival were identified using multivariate unconditional logistic regression analysis. Result A total of 243 ELBW infant were collected. The median gestational age of ELBW infant was 27.3 weeks (23~34 weeks), and their median birth weight was 890 g (490~995 g). Excluding 40 cases refused treatment, the cure and survival rates of the remaining 203 ELBW infants were 43.8% (89/203) and 65.0% (132/203), respectively. The survival rate in ELBW infant with birth weight<600 g was 0/3, increased to 70.8% (68/96) when birth weight was 900 ~999 g, with an ascending trend with increased birth weight (χ2 trend=12.673, P<0.001). The most common complications of 243 cases were neonatal respiration distress syndrome [87.7% (213/243)], sepsis [45.3% (110/243)], intraventricular hemorrhage [37.4% (91/243)], bronchopulmonary dysplasia [36.6% (89/243)] and pheumonia [36.6% (89/243)]. The incidence of complications (including intracerebral hemorrhage and hydrocephalus), decreased with increased birth weight. Multivariate unconditional logistic regression analysis found that birth weight below 800 g (<700 g: OR=22.333, 95%CI 1.493~334.148, P=0.024; 700~799 g: OR=3.573, 95%CI 1.075~11.874, P=0.038), stage Ⅲ necrotizing enterocolitis (OR=8.803, 95%CI 1.308~59.244, P=0.025), stage Ⅲ and Ⅳ of intraventricular hemorrhage (OR=8.902, 95%CI 1.127~70.338, P=0.038) and mechanical ventilation (OR=3.597, 95%CI 1.043~12.410, P=0.043) were risk factors affecting the ELBW infant′s survival. Conclusion As birth weight increases, the survival rate also increases, and the rate of complications decreases. Birth weight, stage Ⅲ necrotizing enterocolitis, stage Ⅲ and Ⅳ intraventricular hemorrhage and mechanical ventilation are risk factors for the ELBW infant′s survival. Key words: Infant, extremely low birth weight; Survival rate; Mortality; Complication; Risk factors

Objective To investigate the hospitalization, outcomes and follow-up results of extremely low birth weight infant (ELBWI). Methods From 1 January 2010 to 31 May 2016, a total of 276 cases of ELBWI who were hospitalized in neonatal intensive care unit of 10 medical institutions, including Maternal & Child Health Hospital of Guangxi Zhuang Autonomous Region, Maternal & Child Health Hospital of Yulin, Maternal & Child Health Hospital of Qinzhou, etc., were chosen as research subjects. Clinical case data and follow-up results of the ELBWI were analyzed retrospectively, including general clinical data of ELBWI and their mothers, common clinical symptoms, complications, sequelaes and follow-up conditions of ELBWI. Among survival and discharged ELBWI, the respiratory therapy between gestational age <28 weeks and ≥28-32 weeks ELBWI were compared statistically by chi-square test and Mann-Whitney U test. This study was in line with World Medical Association Declaration of Helsinki revised in 2013. Results ① General informations of 209 mothers of ELBWI in this study: the twin pregnancy rate was 31.6% (66/209). Top three pregnancy complications in turn of 209 mothers were premature rupture of membrane (27.3%, 57/209), gestational hypertension diseases (19.6%, 41/209) and gestational diabetes mellitus (17.7%, 37/209). ②Top four clinical symptoms in turn of 276 cases of ELBWI in neonatal period were dyspnea (91.7%, 253/276), poor response (75.7%, 209/276), cyanosis of lips or whole body (67.8%, 187/276) and abdominal distention (40.6%, 112/276). ③Top six complications in turn of 276 cases of ELBWI in neonatal period were hyperbilirubinemia (81.2%, 224/276), respiratory distress syndrome (RDS) (75.7%, 209/276), anemia of prematurity (64.1%, 177/276), intrauterine infectious pneumonia (50.0%, 138/276), bronchopulmonary dysplasia (BPD) (48.6%, 134/276) and sepsis (45.7%, 126/276). ④Among 128 cases of ELBWI who were alive and discharged from hospitals, the rate of treatment and duration of respirator assisted ventilation of ELBWI with gestational age <28 weeks were 92.6% and 8.0 d (3.0-16.0 d), respectively, the rate of treatment and duration of continuous positive airway pressure (CPAP) of ELBWI with gestational age <28 weeks were 96.3% and 16.0 d (11.0-25.0 d), respectively, which were all much higher or longer than those of 67.2%, 2.0 d (0-7.5 d), 73.4%, 7.5 d (0-20.0 d) in ELBWI with gestational age ≥28-32 weeks, and all differences were statistically significant (χ2=11.321, P=0.001; Z=-3.994, P<0.001; χ2=11.329, P=0.001; Z=-3.301, P=0.001). ⑤ The survival rate of 276 cases of ELBWI in this study was 46.4%(128/276). Among 276 cases of ELBWI, a total of 88 cases were cured and 40 cases were improved when discharged from hospitals, and 137 cases (49.6%) died in hospitals as ineffective treatments (36 cases) or their guardians gave up treatment to their ELBWI (101 cases), and outcomes of another 11 cases was unknown after they discharged from hospitals by their guardians′ signature. ⑥ Follow-up results of 128 alive and discharged cases showed that 25 cases followed up uncompleted, and the missing rate in this study was 19.5% (25/128). Among 103 cases of ELBWI who followed up successfully, 4 of them died within 6 months after birth. Among infants who have completed follow-up, 48.1%(39/81) of them failed to pass the auditory brainstem response audiometry test, 69.4% (59/85) of them had been diagnosed of retinopathy of prematurity (ROP). Among 99 survival cases who were followed up successfully, ratio of motor and language development retardation were 27.3% (27/99) and 17.2% (17/99), respectively, and only 37.4% (37/99) of them assessed by Gesell Developmental Scale or followed up regularly in neonatology/rehabilitation department. Conclusions The twin birth, premature rupture of membrane and gestational hypertension diseases of mother are the common causes of ELBWI. There are many complications and high mortality rate during the neonatal period of ELBWI. We should take close follow-up after ELBWI discharging from hospitals. Key words: Hospitalization; Outcomes; Evoked potentials, auditory, brain stem; Retinopathy of prematurity; Survival rate; Infant, extremely low birth weight

Objective To study the survival rate, cause of death and the incidence of complications of extremely low birth weight (ELBW) infants. Method Clinical data of the ELBW infants admitted in our hospital between December 2013 and November 2016 were retrospectively analyzed. The cases were assigned into five groups based on gestational age (GA) or birth weight (BW) to further analyze the survival rates among each group. According to the time of death, the cases were assigned into two groups (death within 7 days or after 7 days) to analyze their direct death causes. ELBW infants were categorized into three groups according to GA (< 26 weeks, 26-27 weeks and ≥ 28 weeks) or into two groups according to birth weight (< 750 g and ≥ 750 g) to analyze the incidence of complications within 14 days or after 14 days. Result A total of 122 ELBW infants were enrolled in this study. The mean GA was 27.6±2.1 (range of 22-33) weeks, mean birth weight was 849±112 (range of 525-995) g. GA and BW were both positively correlated with the survival rate. Among all the studied cases, 43 were dead cases. Within these 43 cases, 13 of them died within 7 days. The top 3 causes of death of them were neonatal respiratory distress syndrome (RDS), severe asphyxia and pulmonary hemorrhage of neonatal. The other 30 cases died after 7 days, while the top 3 causes of death of them were sepsis, bronchopulmonary dysplasia (BPD) combined with pneumonia and neonatal necrotizing enterocolitis (NEC). The incidences of complications of all 122 ELBW infants within 14 days of hospitalization were as follow: ELBW infants with BW 0.05). Conclusion As the increasing of GA and BW, the survival rates of ELBW infants increase significantly, and the incidence of complications decline significantly. The complications related to ELBW infants during hospitalization should be prevented to improve the early survival quality of them. Key words: Infant, extremely low birth weight; Survival rate; Cause of death

AimTo investigate growth patterns and anthropometrics in former extremely low birth weight (ELBW, <1000 g) children and link these outcomes to neurocognition and body composition in childhood.MethodsELBW children were examined at birth (n = 140), at 9 and 24 months (n≥96) and at approximately 11 years within the framework of the PREMATCH (PREMATurity as predictor children’s of Cardiovascular and renal Health) case–control (n = 93–87) study. Regional growth charts were used to convert anthropometrics into Z–scores. Catch–up growth in the first two years of life was qualified as present if ΔZ–score >0.67 SDS. At 11 years, anthropometrics, neurocognitive performance, body composition, grip strength and puberty scores were assessed.ResultsELBW neonates displayed extra–uterine growth restriction with mean Z–scores for height, weight and head circumference of –0.77, –0.93 and –0.46 at birth, –1.61, –1.67 and –0.72 at 9 months, –1.22, –1.61 and –0.84 at 24 months, and –0.42, –0.49 and –1.09 at 11 years. ELBW children performed consistently worse on neurocognitive testing with an average intelligence quotient equivalent at 11 years of 92.5 (SD 13.1). Catch–up growth was not associated with neurocognitive performance. Compared to controls, ELBW cases had lower grip strength (13.6 vs. 15.9 kg) and percentage lean body weight (75.1 vs. 80.5%), but higher body fat (24.6 vs. 19.2%) and advanced puberty scores at 11 years (all P≤0.025). Catch–up growth for weight and height in the first two years of life in cases was associated with a lower percentage body fat compared to cases without catch–up growth (16.8% catch-up growth for weight vs. 25.7%, P<0.001; 20.9% catch-up for height vs. 25.8%, P = 0.049).ConclusionsIn young adolescence, former ELBW children still have difficulties to reach their target height. Compared to normal birth weight controls, ELBW adolescents show lower neurocognitive performance and grip strength and a higher percentage body fat, a potential risk factor for adverse health outcomes in adulthood. Our key finding is that catch–up growth in ELBW children in the first two years of life is associated with a lower percentage body fat and is therefore likely to be beneficial.

Prostaglandins (PGs) play a major role in maintaining patency of the ductal arteriosus (DA). Pulmonary 15-hydroxyprostaglandin dehydrogenase (PGDH), which is ecoded by the hydroxyprostaglandin dehydrogenase (HPGD) gene, is the primary enzyme responsible for PG breakdown. Animal studies have shown HPGD-knockout mice have significantly higher prostaglandin E2 levels and no ductal remodeling. Functional variants of the HPGD gene that alter PG breakdown have not been studied in preterm infants with patent ductus arteriosus (PDA). This was an observational cohort study including extreme low birth weight (ELBW) infants classified as having spontaneous, medical, or procedural (transcatheter or surgical ligation) closure of their DA. Urine prostaglandin E metabolite (PGEM) levels were measured in ELBW infants following ibuprofen treatment using competitive ELISA. HPGD genetic variants rs8752, rs2612656, and rs9312555 were analyzed. Kruskal-Wallis, Fisher's exact, chi square, logistic regression, and Wilcoxon signed-rank tests were used; p < 0.05 was considered significant. Infants in the procedural closure group had a younger gestational age (GA). The incidence of spontaneous closure or medical closure was higher compared to procedural closure in the presence of any minor allele of rs8752 (67 and 27%, respectively; p = 0.01), when adjusted for GA and gender. Haplotype analysis of three variants of HPGD revealed differences when comparing the spontaneous and medical closure group to the procedural group (p < 0.05). Urinary PGEM levels dropped significantly in those ELBW infants who responded to ibuprofen (p = 0.003) in contrast to those who did not respond (p = 0.5). There was a different genotype distribution for the rs8752 genetic variant of the HPGD gene-as it relates to the mode of treatment for ELBW infants with PDA. We speculate that medical management in the presence of this variant facilitated additional PG breakdown, significantly abrogating the need for procedural closure. Additionally, differences in genotype and haplotype distributions implicate a specific HPGD genetic foundation for DA closure in ELBW infants. · PGs and their metabolism play a major role in PDA patency or closure.. · Genetic variants of the HPGD gene influence mode of treatment of PDA in ELBW infants.. · ELBW infants with PDA that responded to medical closure had significantly decreased urine PGEM levels..

BackgroundPeritoneal dialysis (PD) for acute kidney injury (AKI) of newborns has been performed safely. AKI occurs in 8 to 24% of extremely low birth weight (ELBW) infants. Although PD has only been used occasionally in ELBW infants, prognosis is poor for ELBW infants with AKI. Several reports have described successful PD in these infants, but no guideline-based evidence concerning indications for renal replacement therapy in ELBW infants are currently available. Here, we report on our experience with PD in an ELBW infant with AKI resulting from septic shock.Case presentationA male was born at 24 weeks and 3 days gestation weighing 264 g by emergency cesarean section due to complications of pregnancy in a patient with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. On day of life (DOL) 15, the inability to ventilate, along with cardiovascular dysfunction, acute kidney injury, and ascites under tension led to the tentative diagnosis of abdominal compartment syndrome (ACS). On DOL 17, placement of a percutaneous drainage tube immediately released compression of the tense abdomen. Although intra-abdominal pressure reduction with percutaneous drainage temporarily improved respiratory status, circulatory impairment persisted and infections were not well controlled. Finally, the patient developed anuria. On DOL 21, peritoneal dialysis (PD) was started by initially inserting a drainage tube. Although the patient had catheter-associated peritonitis, urine output improved by DOL 44 and PD was discontinued on DOL 53. On DOL 75, extubation was conducted without circulatory dysfunction. The patient was discharged on DOL 224.ConclusionsWe emphasize that starting PD treatment before the onset of anuria is important in ELBW infants with AKI. Although the catheter used in our case was initially inserted for drainage of ascites, this type of catheter is sufficiently useful for PD in ELBW infants, and PD using a drainage tube may represent a safe, effective, and minimally invasive treatment for ELBW infants. To our knowledge, this is the first report to describe the use of a percutaneous tube to conduct successful PD for peritoneal drainage in an ELBW infant. This is the lowest-weight ELBW infant with successful PD reported to date.

Background: To determine the effect of Bumetanide (Btd) in Extremely Low Birth Weight (ELBW) infants with Acute Kidney Injury (AKI). Methods: In a retrospective case control study, medical records of all ELBW infants born at our institution (1-1-00 and 1-1-13) and developed AKI were reviewed. Results: 96 ELBW infants were enrolled. Infants who received Btd (n=33) had a lower Birth Weight and higher severity of illness scores at birth than their controls (n=63) [589.0±117.7 vs. 672.3±156.9; p=0.004 and 59.5±15.6 vs. 50.6±17.4; p=0.01 respectively]. 24 hours following the onset of AKI, the urine output increased from 1.5 ± 2.4 to 6.1 ± 9.8 ml/kg/hour (p=0.01) in the Btd group, and from 2.5 ± 2.4 to 3.3 ± 2.9 ml/kg/h (p=0.08) in the control group. The change in 24-hour urine output was significantly higher in the Btd group than the control group [urine output increased by 4.4±9.6 vs. 0.7±3.3 ml/kg/h during the first 24 h of the onset of AKI respectively; p=0.047]. To adjust for possible confounders, a backward linear regression analysis was conducted, Btd was found to be the only independent variable associated with an increase in urine output during the first 24 hours following the onset of AKI (R2=0.114; p=0.005). During the following week, infants who received Btd developed higher serum creatinines than their controls [General Linear Model (GLM); p=0.033]. At discharge, there were no significant differences in serum creatinines between survivors. Conclusions: In ELBW infants with AKI, Btd improved urine output at the expense of increasing serum creatinine

Objective To investigate the hospitalization, outcomes and follow-up results of extremely low birth weight infants (ELBWI). Methods From 1 January 2010 to 1 February 2015, a total of 129 cases of ELBWI in Neonatal Intensive Care Unit (NICU) of Guangxi Zhuang Autonomous Region Maternal and Child Health Hospital were selected as research subjects. A retrospective analysis was conducted to collect their medical records and follow-up data and to analyze their mothers′ general clinical data, main clinical symptoms and complications in neonatal period, the outcomes and follow-up conditions after discharge from hospital. The respiratory therapy conditions between ELBWI with gestational age <28 weeks and ≥28-32 weeks were compared statistically. Results ①Among the 129 cases of ELBWI, the top three pregnancy complications of mothers of ELBWI were gestational hypertension diseases (69.0%, 89/129), premature rupture of membrane (37.2%, 48/129) and gestational diabetes mellitus (16.3%, 21/129), respectively. ②Among the 129 cases of ELBWI, the top five clinical symptoms in neonatal period were dyspnea (96.7%, 126/129), jaundice (85.3%, 110/129), poor response (77.5%, 100/129), abdominal distention (75.2%, 97/129), and body cyanosis (52.7%, 68/129), respectively. ③Among the 129 cases of ELBWI, the top six complications in neonatal period were hyperbilirubinemia (85.3%, 110/129), anemia of prematurity (82.9%, 107/129), nosocomial infection (81.4%, 105/129), respiratory distress syndrome (RDS)(64.3%, 83/129), bronchopulmonary dysplasia(BPD) (50.4%, 65/129) and feeding intolerance (50.4%, 65/129), respectively. ④Among the ELBWI who were alive and discharged from hospital, the usage rate and time of respirator assisted ventilation, the usage rate of continuous positive airway pressure (CPAP) in ELBWI with gestational age <28 weeks all were higher or longer than those in ELBWI with gestational age ≥28-32 weeks, and all the differences were statistically significant (χ2=11.733, Z=-4.963, χ2=11.309; P<0.001). But there was no statistical difference between them in the usage time of CPAP (Z=-1.550, P=0.121). ⑤Among the 129 cases of ELBWI, 98 cases were cured and discharged from hospital, 1 case was referred to another hospital for laser treatment due to ROP, 30 cases died as ineffective treatment or give-up treatment. The follow-up results of 99 alive and discharged cases showed that 11 cases failed to follow up and the rate was 11.1%(11/99), 88 cases were followed up successfully. And among the 99 cases, 53.5% (53/99) failed the auditory brainstem response audiometry test, 42.4% (42/99) cases were combined with ROP. Among the 88 cases who were followed up successfully, rates of motor and language development retardation were 12.5% (11/88) and 4.5% (4/88), respectively, and only 36.4% (32/88) received Gesell Developmental Scale assessment or follow-up in rehabilitation department regularly. Conclusions Gestational hypertension diseases and premature rupture of membrane are the common causes of ELBWI. And there are many complications in neonatal period of ELBWI, so we should take close follow-up after they discharge from hospitals. Key words: Hospitalization; Outcomes; Retrospective studies; Infant, extremely low birth weight

Normal growth outcome in ELBW (≤1kg) infants is considered an indicator of good long term prognosis for health and development. Poor growth in ELBW infants is associated with neonatal illness, and poor neurodevelopmental and psychosocial status. We hypothesized that the incidence and severity of growth failure increases with decreasing BW and GA due to severity of complications of ELBW. In this multicenter study 1151 (78%) of 1527 infants surviving to discharge were evaluated at 18+4 months corrected age; 915 (82%) were appropriate for gestation (AGA) and 204 (18%) were small for gestation(SGA)(Alexander, Obstet Gynecol, 1996). Anthropomorphic measures were obtained using standard techniques. Measures at birth were compared to 36 week weight(Wt), 18 month weight, length (L), head circumference (HC), and weight-to-height ratio (Wt/Ht): Table Median weight, length, and head circumference were lower than standard NCHS data in all BW groups stratified in 100g intervals. Poor growth, ≤10%ile, was seen in all measures at all time points, particularly at 36 weeks, and was inversely related to BW. Failure-to-thrive (FTT) defined as a weight-to-height ratio≤10%ile, was greater in the SGA group vs. AGA group (51% vs 31%, p=0.001). FTT at 18 months was associated with lower BW, SGA, white race, abnormal neurologic diagnosis, and abnormal swallow on logistic regression analysis. These data show a high incidence of poor growth at 18 months in the ELBW infant; we speculate that assessment and aggressive management of health, nutrition, and developmental correlates of growth may improve outcome.

BackgroundDecision Aids (DA) are well established in various fields of medicine. It can improve the quality of decision-making and reduce decisional conflict. In neonatal care, and due to scientific equipoise, neonatologists caring for extreme low birth weight (ELBW) infants are in need to elicit parents' preferences with regard to the use of indomethacin therapy in ELBW infants. We aimed to develop a DA that elicits parents' preferences with regard to indomethacin therapy in ELBW infants.MethodsWe developed a DA for the use of the indomethacin therapy in ELBW infants according to the Ottawa Decision Support Framework. The development process involved parents, neonatologists, DA developers and decision making experts. A pilot testing with healthy volunteers was conducted through an evaluation questionnaire, a knowledge scale, and a validated decisional conflict scale.ResultsThe DA is a computer-based interactive tool. In the first part, the DA provides information about patent ductus arteriosus (PDA) as a disease, the different treatment options, and the benefits and downsides of using indomethacin therapy in preterm infants. In the second part, it coaches the parent in the decision making process through clarifying values and preferences. Volunteers rated 10 out of 13 items of the DA positively and showed significant improvement on both the knowledge scale (p = 0.008) and the decisional conflict scale (p = 0.008).ConclusionWe have developed a computer based DA to assess parental preferences with regard to indomethacin therapy in preterm infants. Future research will involve measurement of parental preferences to guide and augment the clinical decisions in current neonatal practice.