Clinical Outcomes Of Preterm Infants Research Articles

Necrotizing Enterocolitis associated Acute Kidney Injury - transforming the paradigm.

Necrotizing enterocolitis (NEC) is one of the most common conditions requiring emergency surgery in the neonatal intensive care unit and is associated with a septic shock-like state contributing to multi-organ dysfunction. NEC affects 6-10% of very-low birth-weight infants and remains a leading cause of death. The occurrence of severe AKI following surgical NEC is a harbinger of multiple morbidities. This review presents current evidence about the clinical impact of NEC associated AKI on the clinical outcomes. Studies evaluating nephro-protective strategies to prevent AKI and its consequences are greatly needed to improve the post-operative recovery and clinical outcomes in neonates with NEC. Future observational studies and clinical trials in preterm-born infants with NEC prioritize measuring short-term (AKI) and longer term (chronic kidney disease) kidney outcomes. Impact: 1. Severe AKI (stage 2 and 3) occurs in 32.6% of neonates after NEC diagnosis and in 58.7% following surgical NEC diagnosis. 2. NEC associated AKI is associated with severe postoperative course, moderate to severe bronchopulmonary dysplasia, surgical complications, brain injury and longer hospital stay in preterm infants. 3. Severity of NEC associated AKI can be utilized by bedside providers for the prognostication of clinical outcomes in preterm infants.

Effect of family integrated care on stress in mothers of preterm infants: A multicenter cluster randomized controlled trial

BackgroundReducing mother-infant separation in early life is a key breakthrough in the care improvement model in the neonatal intensive care unit (NICU). Previously, we reported effect of family integrated care (FICare) on clinical outcomes of preterm infants. We further clarify effect of FICare on maternal stress. MethodsMothers of preterm infants at eleven NICUs were randomized to the FICare group and the control group. The primary outcome was the reduction in Parental Stress Scale: NICU (PSS:NICU) score from enrollment to discharge. ResultsTotal of 601 mothers (298 in FICare and 303 in control groups) enrolled. There was no significant difference in PSS:NICU score between the 2 groups at enrollment (P = 0.824), and the FICare group had lower scores at discharge (P < 0.001). PSS:NICU scores of both groups were significantly decreased at discharge compared to at enrollment (P < 0.001), and the reduction was greater in the FICare group (P < 0.001). After applying linear regressions to adjust for potential confounders, results remained unchanged (adjusted P < 0.001). PSS:NICU score reductions from enrollment to discharge were positively correlated with maternal age in the control group (ρ = 0.147, P = 0.011). LimitationsThis study was limited to post-hoc analyses and did not include follow-up to evaluate long-term effects. ConclusionsFICare is helpful for reducing maternal stress in preterm infants in the NICU. Older mothers tend to have limited improvements in stress after traditional nonparent care, which suggests that they may benefit more from the FICare model.

Doxapram for the prevention and treatment of apnea in preterm infants.

Doxapram for the prevention and treatment of apnea in preterm infants.

Effect of Probiotic Dose Escalation on Gut Microbiota and Clinical Outcomes in Preterm Infants-A Systematic Review.

Probiotics are known to decrease incidences of necrotising enterocolitis, feeding intolerance, late-onset sepsis, and mortality in preterm infants. Administering an adequate dose is important for optimizing the benefits and safety of probiotics. We conducted a systematic review to assess the effect of probiotic dose escalation on clinical outcomes and gut microbiota in preterm neonates. We searched PubMed, EMBASE, EMCARE, Medline, Cochrane Library, Google Scholar, and MedNar databases in July 2023. Three studies were included. In one of the randomized studies (n = 149, gestation 27 to 33 weeks), no significant differences in faecal Lactobacillus and Bifidobacterium counts and clinical outcomes were seen between the high- and low-dose groups. There was a trend towards increased Lactobacillus and Bifidobacterium counts in the high-dose group. In the other randomized study (n = 120, birth weight 500 to 2000 gm), smaller infants (500 to 1000 gm) required higher doses to display Lactobacillus in their faeces. The cohort study (n = 12, gestation < 33 weeks) showed a trend towards an increase in faecal abundance of bifidobacteria and bacterial diversity in the B. infantis group with increasing dose/time. Limited evidence suggests a higher dose might improve gut colonization in preterm infants. Further studies are urgently needed to address this gap in the knowledge considering the increasing use of probiotics for preterm infants.

Superior Vena Cava flow in preterm infants and neonatal outcomes: A Systematic review.

Superior vena cava (SVC) flow has been considered a surrogate marker of systemic blood flow in neonates. We conducted a systematic review to evaluate association between low SVC flow recorded during the early neonatal period and neonatal outcomes. We searched the following databases (until Dec 9, 2020; updated October 21, 2022): PROSPERO, OVID Medline, OVID EMBASE, Cochrane Library (CDSR and Central), Proquest Dissertations and Theses Global, and SCOPUS using controlled vocabulary and key words representing the concepts "superior vena cava" and "flow" and "neonate". Results were exported to COVIDENCE review management software. The search retrieved 593 records after removal of duplicates, of which 11 studies (9 cohorts) met the inclusion criteria. The majority of the studies included infants born at <30 weeks of gestation. The included studies were assessed as high risk of bias in terms of incomparability of the study groups, with infants in low SVC flow group noted to be more immature than those in the normal SVC flow group or subjected to different co-interventions. We did not conduct meta-analyses in view of significant clinical heterogeneity noted in the included studies. We found little evidence to suggest that SVC flow in early neonatal period is an independent predictor for adverse clinical outcomes in preterm infants. Included studies were assessed at high risk of bias. SVC flow interpretation for prognostication or for making treatment decisions should be restricted to research setting for now. We highlight the need for strengthened methods in the future research studies.

Effect of Maternal Coronavirus Disease on Preterm Morbidities.

Coronavirus disease (COVID-19) during pregnancy may have an impact on preterm morbidities due to the inflammatory nature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Exposure to intrauterine inflammation could result in adverse consequences in preterm infants. We aimed to determine the effect of maternal coronavirus disease on preterm morbidities at a tertiary neonatal intensive care unit. This observational cohort study compared the clinical outcomes of preterm infants < 37 gestational weeks with and without maternal COVID-19. The study was conducted in a tertiary-level neonatal intensive care unit between March 2020 and December 2021. Demographics and clinical data of the study groups were collected from the medical files. A total of 254 infants (127 in the maternal COVID-19 group and 127 in the control group) were included in the study. Respiratory distress syndrome, early and late neonatal sepsis, intraventricular hemorrhage, patent ductus arteriosus (PDA), necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity rates were similar between groups. In the subgroup analysis, the rate of PDA was significantly higher in preterm infants ≤1,500 g with maternal SARS-CoV-2 infection (38 vs. 15% p = 0.023). Presence of maternal COVID-19 was found to be an independent predictor for PDA in very low birthweight infants, as revealed by multivariate analyses (odds ratio: 3.4; 95% confidence interval: 1.12-10.4; p = 0.031). Mortality rates and duration of hospitalization were similar in both groups. Our results suggest that COVID-19 infection during pregnancy seems to have no adverse effect on preterm morbidities and mortality. However, maternal COVID-19 was found to be a risk factor for PDA in preterm infants ≤1,500 g. · The effect of maternal COVID-19 on preterm morbidities still has not well defined.. · Maternal COVID-19 seems to have no adverse effect on preterm morbidities and mortality.. · The exact impact of the COVID-19 on fetal/neonatal health is yet to be clarified..

Oral Application of Mother's Own Milk for Reducing Necrotizing Enterocolitis in Preterm Infants: An Updated Meta-Analysis of RCTs.

Necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) are the major contributors to mortality and morbidity in preterm infants. This updated meta-analysis was aimed to assess the effects of mother's milk on the incidence of NEC, LOS, and other clinical outcomes in preterm infants. PubMed, Embase, and the Cochrane library were searched for papers published up to October 2022. A total of 13 RCTs with 1330 infants were included in the final analysis. Significant difference in NEC (stage 2 or 3) was found between the intervention group and the control group (RR = 0.508, 95% CI: 0.314-0.822, and P=0.008). The incidence of proven LOS (RR = 0.809, 95% CI: 0.610-1.071, and P=0.139) and death (RR = 0.800, 95% CI: 0.571-1.122, and P=0.196) was comparable between the two groups. Statistical differences in the incidence of proven or probable LOS (RR = 0.705, 95% CI: 0.577-0.862, and P=0.001) and length of hospitalization (WMD = -4.868, 95% CI: -6.608 to -3.128, and P < 0.001) between the intervention group and the control group were observed. The results of this updated meta-analysis showed that compared to the placebo, mother's milk provides better effects in reducing the incidences of NEC, proven or probable LOS, and the length of stay, whereas no significant benefit of mother's milk was observed in reducing the incidence of proven LOS and death.

Morbidity and Mortality Trends in Preterm Infants of

Owing to advances in critical care treatment, the overall survival rate of preterm infants born at a gestational age (GA) <32 weeks has consistently improved. However, the incidence of severe intraventricular hemorrhage (IVH) has persisted, and there are few reports on in-hospital morbidity and mortality. Therefore, the aim of the present study was to investigate trends surrounding in-hospital morbidity and mortality of preterm infants with severe IVH over a 14-year period. This single-center retrospective study included 620 infants born at a GA <32 weeks, admitted between January 2007 and December 2020. After applying exclusion criteria, 596 patients were included in this study. Infants were grouped based on the most severe IVH grade documented on brain ultrasonography during their admission, with grades 3 and 4 defined as severe. We compared in-hospital mortality and clinical outcomes of preterm infants with severe IVH for two time periods : 2007-2013 (phase I) and 2014-2020 (phase II). Baseline characteristics of infants who died and survived during hospitalization were analyzed. A total of 54 infants (9.0%) were diagnosed with severe IVH over a 14-year period; overall in-hospital mortality rate was 29.6%. Late in-hospital mortality rate (>7 days after birth) for infants with severe IVH significantly improved over time, decreasing from 39.1% in phase I to 14.3% in phase II (p=0.043). A history of hypotension treated with vasoactive medication within 1 week after birth (adjusted odds ratio, 7.39; p=0.025) was found to be an independent risk factor for mortality. When comparing major morbidities of surviving infants, those in phase II were significantly more likely to have undergone surgery for necrotizing enterocolitis (NEC) (29.2% vs. 0.0%; p=0.027). Additionally, rates of late-onset sepsis (45.8% vs. 14.3%; p=0.049) and central nervous system infection (25.0% vs. 0.0%; p=0.049) were significantly higher in phase II survivors than in phase I survivors. In-hospital mortality in preterm infants with severe IVH decreased over the last decade, whereas major neonatal morbidities increased, particularly surgical NEC and sepsis. This study suggests the importance of multidisciplinary specialized medical and surgical neonatal intensive care in preterm infants with severe IVH.

Comparison of the impact of different fat emulsions on clinical outcomes in preterm infants with varying duration of parenteral nutrition: a randomized controlled multicenter study

To compare the impact of two types of fat emulsion on clinical outcomes in preterm infants with varying duration of parenteral nutrition (PN). Preterm infants meeting the inclusion criteria were randomly assigned to two groups: medium/long-chain triglyceride fat emulsion (referred to as MCT/LCT) group or multi-oil fat emulsion (containing soybean oil, medium-chain triglycerides, olive oil, and fish oil; referred to as SMOF) group. The infants were stratified into groups based on the duration of PN (15-21 days, 22-28 days, and ≥29 days). Clinical characteristics, nutritional status, biochemical indicators, and clinical outcomes were compared between the two groups. Compared with the MCT/LCT group, the SMOF group had lower peak levels of triglyceride during the hospital stay in preterm infants with PN of 15-21 days, 22-28 days, and ≥29 days, respectively (P<0.05). Logistic regression trend analysis showed that with a longer duration of PN, the risk of parenteral nutrition-associated cholestasis (PNAC) and bronchopulmonary dysplasia (BPD) significantly increased in the MCT/LCT group (P<0.05), while the risk of brain injury did not significantly change (P>0.05). In the SMOF group, the risks of PNAC and BPD did not significantly change with a longer duration of PN (P>0.05), but the risk of brain injury significantly decreased (P=0.006). Compared to MCT/LCT, SMOF have better lipid tolerance. With a longer duration of PN, SMOF does not increase the risks of PNAC and BPD and had a protective effect against brain injury. This suggests that in preterm infants requiring long-term PN, the use of SMOF is superior to MCT/LCT.

Clinical and histopathological correlates of intestinal repair in preterm infants following surgical necrotizing enterocolitis

Objective We sought to determine the clinical and histopathological factors linked with intestinal repair and its correlation with clinical outcomes in preterm infants following surgical necrotizing enterocolitis (NEC). Methods A retrospective study has compared clinical and histopathological characteristics between preterm infants with histopathological reparative changes versus non-reparative changes in resected intestinal tissue following surgical treatment of NEC. Reparative changes were defined as microscopic evidence of neovascularization, increased fibroblasts or myofibroblasts, and epithelial regeneration during histopathological examination of the most affected area of resected intestinal tissue. Results The infants with reparative changes (53/148) had significantly lower median birth weight (725 [650−963] vs. 920 [690−1320]; p = .018), higher likelihood of patent ductus arteriosus (38/53 [71.7%] vs. 48/95 [50.5%]; p = .012), longer TPN days (99 [56−147] vs. 76.5 [39−112.5]; p = .034), higher CRP levels (7.3 [3.2−13] vs. 2.6 [1.1−7.8]; p = .011) at NEC onset, and more short bowel syndrome (27/53 [54.0%] vs. 28/95 [32.2%]; p = .012). Those with reparative changes also received more Penrose drain therapy (21/53 [39.6%] vs. 14/95 [14.7%]; p = .011) and had a longer median time to laparotomy (108 h [28−216] vs. 24 [12−96]; p = .003). Epithelial regeneration observed in 6/53 (11.3%) infants lagged fibroblast proliferation and neovascularization changes in the submucosa/muscularis intestinal layers. On a multivariable logistic regression model which included histopathological and clinical factors, inflammation with a percentage <25% area involvement, time from NEC diagnosis to surgery, and Apgar score < 6 at 5 min were independently and significantly associated with higher odds reparative changes. Conclusion In neonates with surgical NEC, the histopathological findings in the resected bowel are significantly associated with clinical characteristics, other histopathological findings, and outcomes. The presence of reparative changes consistent with healing is significantly associated with Apgar score, Penrose drain therapy, longer time from NEC diagnosis to surgery, and lower burden of inflammation in the resected bowel tissue in multivariable analyses. Routine histopathological grading of resected bowel and optimal use of Penrose drain therapy warrant further investigation in the care of neonates with surgical NEC.

Mothers with hypertensive disorders of pregnancy increased risk of periventricular leukomalacia in extremely preterm or extremely low birth weight infants: A propensity score analysis.

BackgroundAt present, the conclusions about the impact of hypertensive disorders of pregnancy (HDP) on the clinical outcomes of preterm infants are inconsistent. This study used the propensity score matching (PSM) analysis to evaluate the effect of HDP on clinical outcomes of extremely preterm or extremely low birth weight (EP/ELBW) infants.MethodsRetrospective analysis was performed on the EP/ELBW infants discharged from 26 tertiary neonatal intensive care units or died during hospitalization from 2008 to 2017, who were divided into HDP group and non-HDP group. The six covariates including sex, gestational age, birth weight, twin or multiple pregnancy, antenatal steroids administration, and conception method were matched through the PSM method at a ratio of 1:1. The survival rate at discharge and the major clinical complications were compared between the two groups.ResultsAfter matching the six covariates, compared with the non-HDP group, there was no significant difference in the survival rate at discharge (64 vs. 63.2%, p > 0.05), the incidence of bronchopulmonary dysplasia (BPD) or moderate to severe BPD in the HDP group (58.3 vs. 54.9%, p > 0.05; 5.2 vs. 6.2%, p > 0.05). The incidence of periventricular leukomalacia (PVL) in the HDP group was significantly increased (5.7 vs. 1.9%, p < 0.05).ConclusionsHDP increased the risk of PVL in EP/ELBW infants, but had no significant effect on the survival rate at discharge, or the occurrence of other complications.

Risk factors of early pulmonary hypertension and its clinical outcomes in preterm infants: a systematic review and meta-analysis

The aim of this meta-analysis was to determine the incidence and risk factors of early pulmonary hypertension (PHT) in preterm infants and evaluate the association of early PHT with morbidities such as bronchopulmonary dysplasia (BPD), late PHT, and in-hospital mortality. We searched the PubMed (1980–2021), Embase (1968–2021), CINAHL (2002–2021), Cochrane library (1989–2021), and KoreaMed (1993–2021). Observational studies on the association between early PHT diagnosed within the first 2 weeks after birth and its clinical outcomes in preterm infants born before 37 weeks of gestation or with very low birth weight (< 1500 g) were included. Two authors independently extracted the data and assessed the quality of each study using a modified Newcastle–Ottawa Scale. We performed meta-analysis using Comprehensive Meta-Analysis version 3.3. A total of 1496 potentially relevant studies were found, of which 8 studies (7 cohort studies and 1 case–control study) met the inclusion criteria comprising 1435 preterm infants. The event rate of early PHT was 24% (95% confidence interval [CI] 0.174–0.310). The primary outcome of our study was moderate to severe BPD at 36 weeks postmenstrual age, and it was associated with early PHT (6 studies; odds ratio [OR] 1.682; 95% CI 1.262–2.241; P < 0.001; heterogeneity: I2 = 0%; P = 0.492). Preterm infants with early PHT had higher OR of in-hospital mortality (6 studies; OR 2.372; 95% CI 1.595–3.528; P < 0.001; heterogeneity: I2 = 0%; P = 0.811) and developing late PHT diagnosed after 4 weeks of life (4 studies; OR 2.877; 95% CI 1.732–4.777; P < 0.001; heterogeneity: I2 = 0%; P = 0.648). Infants with oligohydramnios (4 studies; OR 2.134; 95% CI 1.379–3.303; P = 0.001) and those who were small-for-gestational-age (5 studies; OR 1.831; 95% CI 1.160–2.890; P = 0.009) had an elevated risk of developing early PHT. This study showed that early PHT is significantly associated with mortality and morbidities, such as BPD and late PHT. Preterm infants with a history of oligohydramnios and born small-for-gestational-age are at higher risk for developing early PHT; however, high-quality studies that control for confounders are necessary.

The long-term outcomes of preterm infants receiving non-invasive high-frequency oscillatory ventilation.

ObjectiveTo investigate the clinical outcomes of preterm infants who received non-invasive high-frequency oscillatory ventilation following extubation in a neonatal intensive care unit.MethodsInfants born between 25 and 34 weeks of gestation with a birth weight of <1,500 g, who were admitted into the neonatal intensive care unit of Guangxi Maternal and Child Health Hospital, Nanning, Guangxi, China, requiring mechanical ventilation on admission were randomized to the non-invasive high-frequency ventilation group, nasal intermittent positive pressure ventilation group, or nasal continuous positive airway pressure group following extubation. Their respiratory and neurodevelopmental outcomes were assessed at 12 and 24 months of corrected age.ResultsAmong 149 preterm infants who underwent randomization, 139 completed their treatment in the neonatal intensive care unit (45, 47, 47 in the non-invasive high-frequency ventilation group, nasal intermittent positive pressure ventilation group, or nasal continuous positive airway pressure group, respectively), 113 were assessed at 12-month corrected age, and 110 of 113 were assessed again at 24-month corrected age. There were no differences in the number of times bronchitis, pneumonia, wheezing episodes, and re-hospitalization rates appeared due to respiratory diseases among the three groups (P > 0.05); the pulmonary function tests at 12-month corrected age showed respiratory rate, tidal volume, inspiratory time/expiratory time, time to peak expiratory flow/expiratory time, volume at peak expiratory flow/expiratory volume, expiratory flow at 25, 50, and 75% tidal volume were all similar among infants from the 3 groups (P > 0.05). There were no differences in the rates of neurodevelopmental impairment among the three groups at 24-month corrected age (P > 0.05).ConclusionAs post-extubation respiratory support in preterm infants, non-invasive high-frequency ventilation did not increase the rates of long-term respiratory morbidities and neurodevelopmental impairment compared with nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure.

Outcomes of Preterm Infants Who Experienced Unplanned Extubation.

Unplanned extubation (UE) is associated with adverse outcomes. The aim of the study was to compare the clinical outcomes in preterm infants who experienced at least one UE to those who did not experience any UE. The matched cohort study compared ventilated preterm infants < 32 weeks who experienced UE to those who did not experience any UE. The main outcomes were duration of mechanical ventilation after matching, duration of hospital stay, retinopathy of prematurity (ROP) requiring intervention, and bronchopulmonary dysplasia (BPD). Forty-seven infants were included in each group. The groups were matched for mechanical ventilation duration before UE, birth gestation, and birthweight. The duration of mechanical ventilation after matching (adjusted odds ratio [aOR] 14.8 [11.2-18.4], P = <.001), the total length of stay in the hospital (aOR 16.4 [3.7-29.2], P = .01), and severe ROP (aOR 6.7 [1.7-27.0], P = .007) were significantly higher in infants who experienced UE. After adjusting for mechanical ventilation duration, UE was not associated with ROP or BPD. However, infants who spent longer time on mechanical ventilation had higher odds of developing ROP (aOR 1.1 [1.0-1.2], P = .004) and BPD (aOR 1.5 [1.1-2.1], P = .01). Sensitivity analysis including infants who had UE and managed on noninvasive respiratory support showed significant association between UE and the outcomes of duration of mechanical ventilation, hospital length of stay, ROP, and BPD. Infants who experienced UE had higher odds of spending longer time on mechanical ventilation and spent significantly more days in the hospital.

Clinical outcomes of preterm infants while using automated controllers during standard care: comparison of cohorts with different automated titration strategies

ObjectiveTo compare short-term clinical outcome after using two different automated oxygen controllers (OxyGenie and CLiO2).DesignPropensity score-matched retrospective observational study.SettingTertiary-level neonatal unit in the Netherlands.PatientsPreterm infants (OxyGenie n=121, CLiO2 n=121) born...

Effect of improvement in antibiotic use strategy on the short-term clinical outcome of preterm infants with a gestational age of

To study the effect of improvement in antibiotic use strategy on the short-term clinical outcome of preterm infants with a gestational age of <35 weeks. The medical data were retrospectively collected from 865 preterm infants with a gestational age of <35 weeks who were admitted to the Neonatal Intensive Care Unit of Xiangya Hospital of Central South University from January 1, 2014 to December 31, 2016. The improved antibiotic use strategy was implemented since January 1, 2015. According to the time of implementation, the infants were divided into three groups: pre-adjustment (January 1, 2014 to December 31, 2014; n=303), post-adjustment Ⅰ (January 1, 2015 to December 31, 2015; n=293), and post-adjustment Ⅱ (January 1, 2016 to December 31, 2016; n=269). The medical data of the three groups were compared. There were no significant differences among the three groups in gestational age, proportion of small-for-gestational-age infants, sex, and method of birth (P>0.05). Compared with the pre-adjustment group, the post-adjustment I and post-adjustment Ⅱ groups had a significant reduction in the rate of use of antibiotics and the duration of antibiotic use in the early postnatal period and during hospitalization (P<0.05), with a significant increase in the proportion of infants with a duration of antibiotic use of ≤3 days or 4-7 days and a significant reduction in the proportion of infants with a duration of antibiotic use of >7 days in the early postnatal period (P<0.05). Compared with the post-adjustment Ⅰ group, the post-adjustment Ⅱ group had a significant reduction in the duration of antibiotic use in the early postnatal period and during hospitalization (P<0.05), with a significant increase in the proportion of infants with a duration of antibiotic use of ≤3 days and a significant reduction in the proportion of infants with a duration of antibiotic use of 4-7 days or >7 days (P<0.05). Compared with the pre-adjustment group, the post-adjustment I and post-adjustment Ⅱ groups had significantly shorter duration of parenteral nutrition and length of hospital stay (P<0.05). There were gradual reductions in the incidence rates of grade ≥Ⅲ intraventricular hemorrhage (IVH) and late-onset sepsis (LOS) after the adjustment of antibiotic use strategy. The multivariate logistic regression analysis showed that the adjustment of antibiotic use strategy had no effect on short-term adverse clinical outcomes, and antibiotic use for >7 days significantly increased the risk of adverse clinical outcomes (P<0.05). It is feasible to reduce unnecessary antibiotic use by the improvement in antibiotic use strategy in preterm infants with a gestational age of <35 weeks, which can also shorten the duration of parenteral nutrition and the length of hospital stay and reduce the incidence rates of grade ≥Ⅲ IVH and LOS.

Oral vitamin A supplementation in preterm infants to improve health outcomes: A systematic review and meta-analysis.

ObjectiveTo determine the effects of oral vitamin A supplementation on clinical outcomes in preterm infants.DesignWe conducted the meta-analysis by searching PubMed/Medline, Scopus, Embase, CINAHL, and the Cochrane Library databases from inception to 12 August 2021, including reference lists of retrieved articles. Only randomized controlled trials (RCTs) evaluating the effects of oral vitamin A on premature babies were included. We used a random-effects model to calculate risk ratios (RRs) and weighted mean differences (MDs) with 95% confidence intervals (CIs). We used the GRADE approach to grade evidence quality and assess how oral vitamin A supplementation affects clinical outcomes.Main outcomes measuresThe primary outcomes were respiratory outcomes, including the length of respiratory support, the need for oxygen at 36 weeks postmenstrual age (PMA), and moderate-to-severe bronchopulmonary dysplasia (BPD) at 36 weeks PMA. Secondary outcomes were hospitalization time, vitamin A status, mortality, other related outcomes, and potential adverse drug-related events.ResultsWe included four RCTs, with 800 patients total. In all trials, oral vitamin A treatment was compared to a placebo. Oral vitamin A supplementation did not significantly affect mechanical ventilation duration (MD, −1.07 days; 95% CI, −2.98 to 0.83 days), oxygen requirement at 36 weeks PMA (RR, 0.65; 95% CI, 0.33 to 1.31), or moderate-to-severe BPD at 36 weeks PMA (RR, 0.53; 95% CI, 0.07 to 4.17). However, oral vitamin A supplementation yielded a slightly shorter noninvasive ventilation duration (MD, −0.96 days; 95% CI, −1.59 to −0.33 days).ConclusionsAdministering oral vitamin A to preterm newborns did not alter the mechanical ventilation duration, oxygen needed at 36 weeks PMA, moderate-to-severe BPD at 36 weeks PMA, death, or short-term benefits. However, oral vitamin A supplementation may slightly affect the duration of noninvasive respiratory support without adverse drug-related events.

Implementing the Golden Hour Protocol to Improve the Clinical Outcomes in Preterm Infants

Purpose: Since premature infants are sensitive to the changes in blood glucose levels and body temperature, maintaining these parameters is important to avoid the risk of infections. The authors implemented the Golden Hour protocol (GHP) that aims to close the final incubator within one hour of birth by implementing early treatment steps for premature infants after birth, such as maintaining body temperature, securing airway, and rapidly administering glucose fluid and prophylactic antibiotics by securing breathing and rapid blood vessels. This study investigated the effect of GHP application on the short- and long-term clinical outcomes.Methods: We retrospectively analyzed the medical records between 2017 and 2018 before GHP application and between 2019 and 2020 after GHP application in preterm infants aged 24 weeks or older and those aged less than 33 weeks who were admitted to the neonatal intensive care unit.Results: Overall, 117 GHP patients and 81 patients without GHP were compared and analyzed. Peripheral vascularization time and prophylactic antibiotic administration time were shortened in the GHP-treated group (&lt;i&gt;P&lt;/i&gt;=0.007 and &lt;i&gt;P&lt;/i&gt;=0.008). In the short-term results, the GHP-treated group showed reduced hypothermia upon arrival at the neonatal intensive care unit (&lt;i&gt;P&lt;/i&gt;=0.002), and the blood glucose level at 1 hour of hospitalization was higher (&lt;i&gt;P&lt;/i&gt;=0.012). Furthermore, the incidence of neonatal necrotizing enteritis decreased (&lt;i&gt;P&lt;/i&gt;=0.043). As a long-term result, the incidence of BPD was reduced (&lt;i&gt;P&lt;/i&gt;=0.004).Conclusion: We confirmed that applying GHP improved short- and long-term clinical outcomes in premature infants aged &lt;33 weeks age of gestation, and we expect to improve the treatment quality by actively using it for postnatal treatment.

Oral Application of Colostrum and Mother's Own Milk in Preterm Infants-A Randomized, Controlled Trial.

To evaluate the effects of oral application of mother's own milk (OMOM) on clinical outcomes in preterm infants of 260/7-306/7 wk gestation. In this placebo-controlled randomized trial, subjects received either OMOM or sterile water, beginning at 24-72h of life, until the infant reached 32 wk postmenstrual age or spoon-feeds were initiated, whichever was earlier. The primary outcome was a composite adverse health outcome, defined as the occurrence of either mortality, late-onset sepsis (LOS), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), or retinopathy of prematurity (ROP). Antibiotic usage and time to full enteral feed were secondary outcomes. Salivary IgA (sIgA) levels at baseline and after 7 d of application in a subset of infants were also compared. A total of 133 neonates (66 colostrum and 67 placebo) were analyzed for the primary outcome. OMOM group had lower incidence of composite adverse health outcome (43.9% vs. 61.2%, RR: 0.70; 95% CI: 0.50-0.99, p = 0.046) and LOS (22.7% vs. 43.3%, RR: 0.73; 95% CI: 0.57-0.93; p = 0.012). There were no significant differences in mortality, NEC, IVH, BPD, ROP, and time to full feeds. The effects were more pronounced in the 290/7-306/7 wk subgroup, in whom the colostrum group also achieved full feeds earlier. There were no differences in the change of sIgA levels from baseline to the seventh day of the application. No adverse effects related to the OMOM application were found. OMOM decreases the incidence of late-onset sepsis in preterm neonates (260/7-306/7 wk) and is safe. Clinical Trials Registry-IndiaCTRI/2017/03/008031.

A study comparing short-term outcome in preterm infants of ≤30 weeks gestation between a tertiary neonatal care unit in Bangalore, India and one in London, UK

ABSTRACT Background Large numbers of preterm infants are born in middle-income countries and neonatal care is improving in these countries. Few studies have compared clinical outcome in preterm infants in a tertiary neonatal unit in a middle-income country with one in a high-income country. Objective To compare the short-term outcome in preterm infants of ≤30 weeks gestation admitted to a tertiary neonatal unit in Bengaluru, India and in London, UK. Methods This was a retrospective observational study using anonymised data from electronic patient records. Preterm infants born at ≤30 weeks gestation admitted to neonatal units in Bengaluru (n = 294) and London (n = 740) over a 5-year period (January 2011 to December 2015) were compared. Results Fewer mothers in the Bengaluru centre received antenatal steroids (37% vs 73%, p < 0.001). The incidence of retinopathy of prematurity requiring treatment (12.9% vs 7.7%, NS), treated patent ductus arteriosus (32.3% vs 10.7%, NS) and blood culture-positive sepsis (32.4% vs 1.7%, p < 0.001) was higher in infants in the Indian centre. Overall survival was 83% vs 87.2% (NS) in the Bengaluru and the London cohorts, respectively. Survival of infants born at ≤28 weeks gestation was lower in Bengaluru than in London [24 weeks: 33.0% vs 79.3% (NS); 25 weeks: 50.0% vs 78.9%, p = 0.02; 26 weeks: 45.2% vs 86.5%, p < 0.01; 27 weeks: 79.3% vs 91.3% (NS); 28 weeks 82.5% vs 94.1%, p = 0.03]. Conclusion The survival of infants ≤28 weeks gestation was significantly lower in the Bengaluru centre. Increasing the provision of antenatal corticosteroids may improve the outcome in these infants. Abbreviations BPD: bronchopulmonary dysplasia; CPAP: continuous positive airway pressure; EPR: electronic patient records; HIC: high-income countries; HDU: high dependency unit; hsPDA: haemodynamically significant patent ductus arteriosus; IVH: intraventricular haemorrhage; ITU: Intensive Care Unit, IUGR: intrauterine growth restriction; LAMA: leaving against medical advice; LMIC: low- and middle-income countries; NICU: neonatal intensive care unit; NNFI: National Neonatal Forum of India; NS: not significant; NTS: neonatal transfer service; NNAP: National Neonatal Audit Programme; NHM: National Health Mission; NMR: neonatal mortality rate; NEC: necrotising enterocolitis; NS: not significant; PDA: patent ductus arteriosus; ROP: retinopathy of prematurity; SCBU: special care baby unit; VLBW: very low birthweight; WHO: World Health Organization