Assessment Of Preterm Infants Research Articles

Application of Serum Aminoterminal Pro-brain Natriuretic Peptide and Interleukin-6 Levels in Early Diagnosis and Severity Assessment of Preterm Infants with Respiratory Distress Syndrome

Objective To evaluate the value of serum aminoterminal pro-brain natriuretic peptide (NT-proBNP) and interleukin(IL)-6 levels in diagnosis and severity assessment of the preterm infants with respiratory distress syndrome(RDS).Methods Totally 150 preterm infants with RDS who were hospitalized in our center from August 2016 to March 2018 were enrolled in this study as the RDS group. These infants were further divided into grades 1,2,3,and 4 according to chest radiography. In addition,158 preterm infants without RDS hospitalized in our center during the same period were included as the controls (control group). Serum NT-proBNP and IL-6 levels were measured by ELISA on days 1,3,and 7 after birth,and their pulmonary arterial pressure (PAP) was monitored as well.Results Serum NT-proBNP and IL-6 levels in RDS group were significantly higher than those in control group on day 1 (t=-91.04,P=0.000;t=-11.03,P=0.000),day 3 (t=-89.10,P=0.000;t=-9.909,P=0.000),and day 7 (t=-87.91,P=0.000;t=-8.548,P=0.000). There were significant differences in NT-proBNP levels among grades 1,2,3,and 4 on day 1 (F=50.89,P=0.000),day 3 (F=49.16,P=0.000),and day 7 (F=45.45,P=0.000),showing an increasing trend. Serum IL-6 levels showed no significant difference among grades 1,2,3,and 4 on day 1 (F=0.89,P=0.448),day 3 (F=0.76,P=0.518),and day 7 (F=0.85,P=0.469). The PAP of the RDS group on days 1,3,and 7 was (49.3±3.7),(40.1±5.4),and (39.0±2.6)mmHg (1 mmHg=0.133 kPa),which were significantly higher than those of the control group (35.0±2.7)mmHg (t=-90.01,P=0.000),(30.0±3.1)mmHg (t=-81.90,P=0.000),(26.0±3.0)mmHg (t=-88.89,P=0.000). Thus,there was a positive correlation between NT-proBNP and IL-6 levels (r=0.876,P=0.000) and a positive correlation between NT-proBNP and PAP (r=0.916,P=0.000) in preterm infants with RDS.Conclusion Monitoring serum NT-proBN contributes to early diagnosis and disease severity assessment in preterm infants with RDS.

Correlation of the Bayley scales of infant-toddler development-3rd edition and neuro-sensory motor assessment in preterm infants during the first year of life.

Kaya-Kara Ö, Kerem-Günel M, Yiğit Ş. Correlation of the Bayley scales of infant-toddler development-3rd edition and neuro-sensory motor assessment in preterm infants during the first year of life. Turk J Pediatr 2019; 61: 399-406. The aim of this study was to determine the best cut-off score for determining motor delay in the Motor Scale of the Bayley Scales of Infant-Toddler Development-3rd Edition (Bayley-III) when compared to the Neuro-Sensory Motor Development Assessment (NSMDA) for low birth weight and preterm infants during the first year of life. One hundred and sixty infants born before 32 weeks of gestation and with birth weights of 1500 grams or less were included. Classifications of delay using different Bayley-III cut-offs were cross-tabulated with the NSMDA functional classification. Predictive values of sensitivity, specificity, positive predictive value, and negative predictive value were calculated with 95% CIs. The sensitivity of a Bayley-III cut-off < 85 was 100% at 1, 8, and 12 months and 92.3% at 4 months. The best score on the Bayley-III for identifying infants with mild/moderate/severe motor problems on the NSMDA was 80 (100% at 1, 4, and 8 months; 91.3% at 12 months). For identifying motor impairments using the Bayley-III in low birth weight and preterm infants at 1, 4, 8, and 12 months old, the proper cut-off scores are 80-85.

Behavioral Organization in Infants with Intraventricular Hemorrhage: Characteristics and Clinical Implications.

This study examined the neurobehavioral functioning in preterm infants diagnosed with intraventricular hemorrhage (IVH) grades III and IV, using the Assessment of Preterm Infants' Behavior (APIB). The APIB was completed on nine infants with IVH III/IV at 36 and 40weeks postmenstrual age to determine the effects of IVH on the neurobehavioral functioning and maturation over time. The APIB neurobehavioral scores (i.e., physiologic, motor, state, attention/interaction, regulatory, and examiner facilitation subsystem scores) were examined in relation to the two different testing times and to infants without lesion. APIB scores at 36weeks suggested easily disorganized and poorly modulated behavioral regulation and low threshold of disorganization and stress. At 40 weeks, poor overall behavioral regulation persisted; only motor differences statistically improved between the two ages. Neurobehavior was significantly poor in all but state subsystems when tested at both ages in infants with a brain lesion.

Preterm infants have significantly longer telomeres than their term born counterparts.

There are well-established morbidities associated with preterm birth including respiratory, neurocognitive and developmental disorders. However several others have recently emerged that characterise an ‘aged’ phenotype in the preterm infant by term-equivalent age. These include hypertension, insulin resistance and altered body fat distribution. Evidence shows that these morbidities persist into adult life, posing a significant public health concern. In this study, we measured relative telomere length in leukocytes as an indicator of biological ageing in 25 preterm infants at term equivalent age. Comparing our measurements with those from 22 preterm infants sampled at birth and from 31 term-born infants, we tested the hypothesis that by term equivalent age, preterm infants have significantly shorter telomeres (thus suggesting that they are prematurely aged). Our results demonstrate that relative telomere length is highly variable in newborn infants and is significantly negatively correlated with gestational age and birth weight in preterm infants. Further, longitudinal assessment in preterm infants who had telomere length measurements available at both birth and term age (n = 5) suggests that telomere attrition rate is negatively correlated with increasing gestational age. Contrary to our initial hypothesis however, relative telomere length was significantly shortest in the term born control group compared to both preterm groups and longest in the preterm at birth group. In addition, telomere lengths were not significantly different between preterm infants sampled at birth and those sampled at term equivalent age. These results indicate that other, as yet undetermined, factors may influence telomere length in the preterm born infant and raise the intriguing hypothesis that as preterm gestation declines, telomere attrition rate increases.

The Clinical and Biochemical Predictors of Bone Mass in Preterm Infants.

BackgroundMetabolic bone disease of prematurity still occurs in preterm infants, although a significant improvement in neonatal care has been observed in recent decades. Dual-energy X-ray absorptiometry (DXA) is the precise technique for assessing bone mineral content (BMC) in preterm infants, but is not widely available.AimTo investigate the clinical and biochemical parameters, including bone metabolism markers as potential predictors of BMC, in preterm infants up to 3 months corrected age (CA).Materials and MethodsCa-P homeostasis, iPTH, 25-hydroxyvitamin D, osteocalcin, N-terminal propeptide, cross-linked C-telopeptide and amino-terminal pro C-type natriuretic peptide and the DXA scans were prospectively performed in 184 preterm infants (≤ 34 weeks’ gestation) between term age and 3 mo CA. Lower bone mass was defined as BMC below or equal to respective median value for the whole study group, rounded to the nearest whole number.ResultsThe appropriate quality DXA scans were available for 160 infants (87%) examined at term and for 130 (71%) tested at 3 mo CA. Higher iPTH level was the only independent predictor of lower BMC at term, whereas lower BMC at 3 mo CA was associated both with lower urinary phosphate excretion and higher serum osteocalcin level. ROC analysis showed that iPTH >43.6 pg/mL provided 40% sensitivity and 88% specificity in identification of preterm infants with lower BMC at term. In turn, urinary phosphate excretion (TRP>97% or UP/Cr ≤0.74 mg/mg) and serum osteocalcin >172 ng/mL provided 40% sensitivity and 93% specificity in identification of infants with decreased BMC at 3 mo CA.ConclusionSerum iPTH might to be a simple predictor of reduced BMC in preterm infants at term age, but urinary phosphate excretion and serum osteocalcin might predict reduced BMC at 3 mo CA. These results represent a promising diagnostic tool based on simple, widely available biochemical measurements for bone mass assessment in preterm infants.

CareToy: Stimulation and Assessment of Preterm Infant's Activity Using a Novel Sensorized System.

Early intervention programs aim at improving cognitive and motor outcomes of preterm infants. Intensive custom-tailored training activities are usually accompanied by assessment procedures, which have shortcomings, such as subjectivity, complex setups, and need for structured environments. A novel sensorized system, called CareToy, was designed to provide stimulation in the form of goal-directed activity training scenarios and motor pattern assessment of main developmental milestones, such as rolling activity, grasping, and postural stability. A group of 28 differently skilled preterm infants were enrolled. Acquired measurement data were analysed with dedicated sensor data processing algorithms, along with clinical evaluation of motor ability. High correlation among technically determined parameters and Alberta Infant Motor Scale values was determined by Pearson correlation coefficients. Due to good accuracy and possibility of single motor skill subfield analysis, results confirm system suitability for motor ability assessment. Statistical analysis of inter-motor ability group and inter-training goal data comparisons demonstrate system's appropriateness for goal-directed activity stimulation. The proposed system has evident potential of being an important contribution to the field of infant motor development assessment, expanding accessibility of early intervention programs and affecting rehabilitation effectiveness of preterm infants.

Concurrent validity of the Bayley Scales of Infant &amp; Toddler Development‐3rd edition and Neuro Sensory Motor Developmental Assessment in preterm infants

Concurrent validity of the Bayley Scales of Infant &amp; Toddler Development‐3rd edition and Neuro Sensory Motor Developmental Assessment in preterm infants

Nutritional Management and Assessment of Preterm Infants

This article provides a comprehensive review on the nutritional management of preterm infants. The review also describes the methodology developed and implemented in the BabyGrow longitudinal nutrition and growth study to assess the nutritional status of preterm infants. Nutrient intake data revealed substantial cumulative protein deficits, which persisted for at least 5 weeks of life at the same time as energy excesses were accumulating. These data show that actual nutrient intake assessment is important for developing effective nutritional strategies. Postnatal growth was evaluated, and body composition was assessed by air displacement plethysmography up to 2 months corrected age.

Evaluation of functional performance assessment in preterm infants with Infant Neurological International Battery

Context: Many studies have found that there is an increased risk of neurodevelopmental impairments in preterm and low birth weight (LBW) infants, so it is desirable to make early predictions with regard to outcome. This is important for the family, for the researchers designing appropriate follow-up and intervention programs, and for the pediatric neurologist who has to give meaningful feedback to obstetricians and neonatologists. Several studies have tried to identify infants at particularly high risk of neurological damage. In 1972, Drillien described transitory dystonia of the LBW premature infant as a common developmental deviation of motor function during the 1 st year of life. Aims: To evaluate the functional performance (age specific motor development) in preterm infants using Infant Neurological International Battery (INFANIB). Settings and Design: Observational study design conducted at physiotherapy OPD. Subjects and Methods: An observational study was carried out in 100 infants who were born at 24-31 weeks gestation with age group from 4 to 9 months with a mean age of 4.3 months. The sample selection was based on convenient sampling method. The infants were evaluated according to their gestational age. The study was approved by Institutional Ethical Committee. The guardians signed an informed consent form allowing the infant's participation. INFANIB was administered on 100 preterm infants, and collected data were compared with standard values of INFANIB. Statistical Analysis Used: Unpaired t-test was used for between group comparisons. Results: The present study shows that premature infants have high risk of delayed pattern of motor development which is different from those infants born at term. Conclusions: The premature infants show delayed pattern of motor development that is different from those born at term.

Predicting the outcome of specific language impairment at five years of age through early developmental assessment in preterm infants

BackgroundVery preterm infants (<30weeks of gestation) are at increased risk of specific language impairment and systematic developmental follow-up is essential for the provision of targeted early intervention. AimsTo define the predictive value of early language testing and stability of language development, and perinatal and demographic risk factors for the diagnosis of SLI at 5years, in a cohort of preterm infants. Study designWe used a retrospective hospital based cohort study. SubjectsPreterm infants <30weeks of gestation, were cared for in NICU at RPAH, between 2004 and 2007, and prospectively enrolled in developmental follow-up. Standardised developmental assessment was done at 3years utilising the Bayley Scales of Infant and Toddler Development-III and the Wechsler Preschool and Primary Scale of Intelligence-III was done at 5years. Outcome measuresPredictive value and stability of early language testing were assessed with respect to SLI at 5years, using measures of diagnostic accuracy and kappa values. Multivariate logistic regression was performed during the distribution of perinatal and demographic risk factors for SLI. ResultsOne-in-five met diagnostic criteria for SLI (19%, n=24). Limited diagnostic accuracy was found with early expressive language and the stability of language scores demonstrated only fair agreement (Cohen's κ .383). Multilingual status and extreme gestational age at 24–25weeks were associated with a six-fold increased risk of SLI (OR 6.09, 95% CI 1.89–19.56; OR 6.09, 95% CI 1.28–29.0). ConclusionWe defined a high incidence of SLI among our cohort, but only a limited diagnostic accuracy of early language testing. Multilingual status and extreme prematurity were independent risk factors for SLI. It remains imperative to perform continued developmental assessments beyond pre-school age to identify language impairment with greater accuracy.

PC.39 Reliability of Myocardial Performance Assessment in Preterm Infants using Strain and Strain Rate: A comparison Between Left ventricular, Septal and Right ventricular Walls

ObjectiveTo assess the reliability of longitudinal strain (LS) and strain rate (SR) in the very low birth weight infants.Design/MethodsLS and SR were measured in infants less than 28 weeks corrected...

Post discharge growth assessment in preterm infants. Implications of adopting the WHO standards

Post discharge growth assessment in preterm infants. Implications of adopting the WHO standards

Evaluación posalta del crecimiento en prematuros. Implicaciones de adoptar las curvas OMS

The WHO standards have been used as a gold standard for growth assessment in preterm infants since 1986. The introduction of the WHO standards in Argentina could improve detection of sub-optimal growth. To compare the proportion of growth retardation in terms of weight, body height and head circumference in preterm infants with a birth weight less than 1500 g (VLBW) assessed according to the WHO standards and the Sociedad Argentina de Pediatría (SAP) standards. Cohort study in VLBW newborn infants. Measurements included were weight, height and head circumferences measured at 40, 53, 66, 79 and 92 postmenstrual weeks (±1 week). Sex was recorded as an independent outcome measure for both standards (WHO and SAP). Mean Z scores were analyzed for both standards using Student's test, and the difference of proportions was assessed using the c2 test (OR; 95% CI). Two hundred and four infants were included. No differences were observed in anthropometric outcome measures at birth by sex. A greater growth was seen in terms of weight and height as per the SAP standards compared to the WHO standards, which was more marked in male infants than female infants, and which diminished around their first year of life. Growth retardation in terms of height was observed in both males and females assessed with the WHO standards. No differences were observed in head circumference. A higher proportion of patients with a weight below 2 standard deviations at 3 months old was found as per the WHO (p < 0.01; OR: 0.36; 95% CI: 0.150.78), but that was not the case with height and head circumference. This study allows to suggest that changing the standards does not imply a significant modification in our follow-up practice over the first year of life of an infant.

Evaluation of air-displacement plethysmography for body composition assessment in preterm infants

Adiposity may contribute to the future risk of disease. The aim of this study was to evaluate the accuracy and reliability of an air-displacement plethysmography (ADP) system to estimate percentage fat mass (%FM) in preterm infants and to evaluate interdevice reliability in infants. A total of 70 preterm and 9 full-term infants were assessed. The accuracy of ADP measurements was assessed by determining reference %FM values using H(2)(18)O dilution measurement. Mean %FM by ADP was 5.67 ± 1.84 and mean %FM by H(2)18O dilution was 5.99 ± 2.56. Regression analysis showed that %FM by ADP was associated with %FM by H(2)(18)O dilution (R2 = 0.63, SE of estimate (SEE) = 1.65, P = 0.006). Bland-Altman analysis showed no bias (r = -0.48, P = 0.16) and 95% limits of agreement were -3.40 to 2.76 %FM. There was no difference in mean interdevice reliability %FM values (8.97 vs. 8.55 %FM) between ADP 1 and 2. Regression analysis indicated a low SEE (1.14% FM) and high R2 (0.91); 95% limits of agreement were -1.87 to 2.71 %FM. The regression line did not differ significantly from the line of identity. ADP is a noninvasive, reliable, and accurate technique to measure preterm infants' body composition in both research and clinical settings.

Neonatal assessments for the preterm infant up to 4 months corrected age: a systematic review

The aim of this study was to systematically review the clinimetric properties of longitudinal neonatal neurobehavioural and neuromotor assessments for preterm infants. Twenty-seven assessment measures were identified. The following eight measures met the study inclusion criteria: Assessment of Preterm Infants' Behaviour (APIB), Neonatal Intensive Care Unit Network Neurobehavioural Scale (NNNS), Test of Infant Motor Performance (TIMP), Prechtl's Assessment of General Movements (GMs), Neurobehavioural Assessment of the Preterm Infant (NAPI), Dubowitz Neurological Assessment of the Preterm and Full-term Infant (Dubowitz), Neuromotor Behavioural Assessment (NMBA), and the Brazelton Neonatal Behavioural Assessment Scale (NBAS). The primary purposes included prediction (TIMP, GMs, Dubowitz), discrimination (all assessments), and evaluation of change (TIMP, NAPI). Measures of assessment were included in the study if they were (1) primarily neurobehavioural or neuromotor assessments that were suitable for use with preterm infants (<37 weeks gestation) up to 4 months corrected age and were discriminative, predictive, or evaluative; (2) standardized procedures designed for serial/longitudinal use; or (3) criterion or norm referenced. However, all assessment tools that were not published in English in a peer-reviewed journal or were primarily neurological assessments, one-time evaluations, screening tools, or not commercially available were not used. All of the measures included in the review demonstrated adequate content and construct validity. Concurrent validity was reported for APIB, NNNS, Dubowitz, and GMs. Predictive validity was high for GMs with studies reporting up to 100% senstivity for predicting cerebral palsy at the age of 12 to 24 months. Interrater reliability was strong for the TIMP (intraclass correlation=0.95), GMs (K=0.8), and moderate for the NAPI (r=0.67-0.97). Clinical utility was variable for ease of scoring, interpretability, cost, and access. In the absence of a criterion standard for neonatal neuromotor assessments, the NNNS and APIB have strong psychometric qualities with better utility for research. Similarly, the GMs, TIMP, and NAPI have strong psychometric qualities but better utility for clinical settings. The GMs has best prediction of future outcome and the TIMP has best evaluative validity.

Early visual assessment in preterm infants with and without brain lesions: Correlation with visual and neurodevelopmental outcome at 12 months

Background Several studies have reported the development of various aspects of visual function in infancy and early childhood in both preterm and term-born infants, but only a few studies have focused on the predictive power of neonatal visual findings in infants with brain lesions. Aims To explore visual findings at term age, and at 3 and 12 months corrected age in preterm infants (gestational age < 33 weeks) with and without brain lesions; to compare the assessment at term age and at 12 months; and to assess the relationship between visual findings and neurodevelopmental outcome at 12 months. Study design Cranial ultrasound scans (US) were classified in normal, mild or major abnormalities. One-hundred and forty-five infants were assessed with age specific tests for visual function at term age, and at 3 and 12 months. Neurodevelopmental assessment (Griffiths' Scales) was performed at 12 months. Results A good correlation was found between early and late visual assessment and neurodevelopment outcome. Of the 121 infants with normal neonatal visual assessment, 119 were also normal at 12 months and 116 had normal developmental quotient. Of the 24 infants with abnormal neonatal visual assessment, 12 were also abnormal at 12 months. All the false positives had normalised by 3 months. Of the 35 infants with major US abnormalities, 20 had normal and 15 abnormal scores on the neonatal assessment. At 1 year 17 had normal and 18 abnormal scores. Conclusion A normal visual assessment at term age is a good predictor of normal visual and neurodevelopmental outcome at 12 months. An abnormal visual examination in the neonatal period was a less reliable prognostic indicator, infant should be reassessed at 3 months.

The neurological examination of non-complicated preterm newborns using the Saint-Anne Dargassies Scale from birth to term

To describe the maturational development of 20 (aged 32-36 weeks) premature newborns (PNBs) without clinical or neurological complications from birth until term. The Saint-Anne Dargassies Scale was applied every two weeks until the age of 37 weeks. The PNBs showed normal Apgar and the growth in head circumference was adequate for postmentrual age. The Friedman ANOVA test found a significant difference only for the heel-to-ear angles from birth until term. The Saint-Anne Dargassies Scale detected changes in 11 PNBs and the most altered reflexes were: cardinal points, Moro, cross extension reflexe and automatic walking. These changes were found in the first 48 hours of life and in subsequent weeks until term. This finding alone justifies the neurological examination of PNBs, even if they show no clinical/neurological complications in the perinatal period and the importance of neuromotor assessment in preterm infants, as it enables detection and appropriate intervention.

1148 Early Comunicative and Language Development in Preterm Infants without Neurological Damage

Aims: This study aims to explore the role of biological and enviromental factors as predictors of the early comunicative and language development, comparing 12 Italian preterm infants without central nervous system insults and 12 Italian full-term infants.Method: All participants were assessed longitudinally through the questionnaire “Il Primo Vocabolario del Bambino” (PVB), administered monthly to the mothers between 11 and 18 months of age. Assessing preterm infants both chronological age and age correction for prematurity were applied. The measures derived by PVB were: gestures production, words comprehension and production in each age.Results: Results - on the basis of chronological age - indicated that preterm infants exhibited an initial and transient delay and disharmonic profiles in all aspects examined, with scores within the lower limits of typical development range. Otherwise, on the basis of age correction, preterm infants show performances, since the first observations, on or over the mean value.Conclusions: Using the age correction for prematurity the communicative and language abilities of preterm infants were overestimated and the initial delay of language development was underestimated. Findings are discussed considering the role of gestational age, but also of environmental factors, on early language development and the utility of correct age on the assessment of preterm infants during the second year of age.

An Evidentiary Review Regarding the Use of Chronological and Adjusted Age in the Assessment of Preterm Infants

The evidence supporting the recommendation to use age adjustment when assessing the growth, motor, and global development of premature infants was explored. Following a comprehensive literature search, 16 articles that compared the use of adjusted and chronological age were reviewed. The use of full age adjustment based on the degree of prematurity was supported for the assessment of premature infants for a minimum of 12 months adjusted age. The use of adjusted age enhances the ability to accurately recognize genuine delays as opposed to perceived delays related to a child's gestational age at birth.

Neonatal echocardiographic assessment in preterm infants born from twin to twin transfusion syndrome treated by fetoscopic laser coagulation: Comparison with dichorionic twins

UENPS.371 From a dustbin to NICU: Successful treatment of profound neonatal hypothermia Patricia Konopova⁎, Jan Janota, Jana Termerova, Iva Burianova, Hana Martanova, Magdalena Paulova, Jiri Zach Thomayer University Hospital, Prague Background and aim Severe neonatal hypothermia is defined as a core body temperature below 28 °C. The development of hypothermia can be predisposed by numerous factors including hypoglycaemia, drugs, and environmental exposure. At present, there is no agreement regarding the best therapeutic approach [1]. We report the treatment of profound hypothermia in a newborn with subsequent full recovery. Materials and methods Term male newborn was found uncovered in a dustbin, with umbilical cord attached to placenta. He was exposed to environmental temperature of −3 °C for approximately 30 min. The core temperature on admission was 25 °C. He was spontaneously breathing, had hypotension, bradycardia, and poor peripheral perfusion. Vigorous treatment was commenced, including non-aggressive, slow re-warming at 0.5–1.0 °C per hour using external warming modalities, oxygen, volume expanders, heparinization, and antibiotic treatment. Results During first 24 h rectal temperature raised from 25 °C to 37 °C, heart rate from 60 to 140/minute (Fig. 1). No adverse effects were observed during, and after re-warming. The following tests were performed during the hospitalisation and were normal: neurological examination, cranial ultrasound, EEG, hearing, and ophthalmology screen. At the time of discharge (day 21), the newborn had no significant neurological abnormalities. Fig. 1. Rectal temperature and heart rate within first 24 hours. Conclusions A slow re-warming procedure can be successfully used when treating a profoundly hypothermic newborn.