Cohort Of Extremely Low Birth Weight Infants Research Articles

Postneonatal mortality of severely small for gestational age extremely low birth weight infants

Infants born with weights below the 10th percentile of the expected birth weight for gestational age, defined as small for gestational age (SGA), have an increased risk of neonatal mortality and prematurity-related complications. However, the relationship between SGA and postneonatal (28 days to <1 year) mortality among extremely low birth weight infants (ELBWIs) remains uncertain. Hence, this study aimed to investigate the association between birth weight percentiles and postneonatal mortality in ELBWIs. A cohort of ELBWIs with a gestational age greater than 23 weeks who were admitted to Osaka Women's and Children's Hospital between 2008 and 2019 were considered eligible. Infants with major congenital anomalies, those large for their gestational age, or those who died within 28 days of birth were excluded. Baseline characteristics and outcomes of the three groups of ELBWIs-severe SGA (sSGA; birth weight, <3rd percentile), moderate SGA (mSGA; birth weight, 3rd to <10th percentile), and appropriate for gestational age (AGA; birth weight, 10th to <90th percentile)-were compared. Logistic regression analysis was used to identify perinatal factors associated with postneonatal mortality in sSGA infants. sSGA ELBWIs demonstrated higher incidence of meconium obstruction (25% vs. 8.3% vs. 7.6%, P<0.001), cholestasis (21% vs. 4.2% vs. 9.7%, P<0.003), and postneonatal mortality (7.3% vs. 0% vs. 0.7%, P<0.004) than mSGA and AGA ELBWIs. In the logistic regression analysis, cholestasis (odds ratio, 30.1; 95% confidence interval, 2.98-304) and sepsis (odds ratio, 13.5; 95% confidence interval, 1.06-173) were significantly related to postneonatal mortality among ELBWIs with sSGA. The leading cause of postneonatal mortality in sSGA ELBWIs was liver failure (55.5%). sSGA ELBWIs exhibited a higher rate of postneonatal mortality compared to mSGA and AGA ELBWIs. Therefore, strategies aimed at preventing liver dysfunction in severely cholestatic ELBWIs with sSGA are necessary.

Interaction of hydrocortisone and illness severity on head growth in cohort of ELBW infants.

Extremely low birth weight (ELBW) infants comprise a fragile population at risk for neurodevelopmental disabilities (NDD). Systemic steroids were previously associated with NDD, but more recent studies suggest hydrocortisone (HCT) may improve survival without increasing NDD. However, the effects of HCT on head growth adjusted for illness severity during NICU hospitalization are unknown. Thus, we hypothesize that HCT will protect head growth, accounting for illness severity using a modified neonatal Sequential Organ Failure Assessment (M-nSOFA) score. We conducted a retrospective study that included infants born at 23-29 weeks gestational age (GA) and < 1000 g. Our study included 73 infants, 41% of whom received HCT. We found negative correlations between growth parameters and age, similar between HCT and control patients. HCT-exposed infants had lower GA but similar normalized birth weights; HCT-exposed infants also had higher illness severity and longer lengths of hospital stay. We found an interaction between HCT exposure and illness severity on head growth, such that infants exposed to HCT had better head growth compared to those not exposed to HCT when adjusted for illness severity. These findings emphasize the importance of considering patient illness severity and suggest that HCT use may offer additional benefits not previously considered. This is the first study to assess the relationship between head growth and illness severity in extremely preterm infants with extremely low birth weights during their initial NICU hospitalization. Infants exposed to hydrocortisone (HCT) were overall more ill than those not exposed, yet HCT exposed infants had better preserved head growth relative to illness severity. Better understanding of the effects of HCT exposure on this vulnerable population will help guide more informed decisions on the relative risks and benefits for HCT use.

Exposure to antenatal corticosteroids and reduced respiratory sinus arrhythmia in adult survivors of extremely low birth weight

Purpose/aim: Antenatal corticosteroid (ACS) therapy has dramatically increased survival rates among extremely low birth weight (ELBW) infants. However, the long-term effects of ACS on autonomic nervous system function have not been explored. Using the world’s oldest longitudinally followed cohort of ELBW infants we compared respiratory sinus arrhythmia (RSA) among ELBW survivors whose mothers received ACS (ELBW-S), those who did not (ELBW-NS) and normal birth weight (NBW) controls in their 20 and 30 s.Methods: Resting electrocardiogram (ECG) was recorded from ELBW-S (n = 28), ELBW-NS (n = 36), and matched NBW controls (n = 79) at 22–26 and 29–36 years. Resting RSA was compared across groups via analyses of covariance (ANCOVA), adjusting for sex, medication use, postnatal steroid exposure and the presence of chronic health conditions. RSA was also compared across assessments for each group.Results: At 29–36 years, resting RSA in ELBW-S was significantly lower than in NBW controls. RSA in the ELBW-NS group was intermediate between ELBW-S and NBW groups. Although the ELBW-S group also showed nominally reduced RSA compared to NBW controls at the 22–26-year visit, this difference was not statistically significant.Conclusions: ELBW survivors exposed to ACS had lower RSA than NBW controls during their 30 s, suggestive of a decline in parasympathetic input to heart. ELBW survivors who received ACS may be particularly vulnerable to cardiovascular problems in later life.

SaO043NEONATAL CREATINEMIA TRENDS AS BIOMARKER OF SUBSEQUENT COGNITIVE OUTCOME IN EXTREMELY LOW BIRTH WEIGHT NEONATES

article Background and aims:Serum creatinine is traditionally used as a marker of renal function in neonates and relates to gestational age and disease severity in extremely low birth weight (ELBW) infants. Creatinine is commonly used as a biomarker for early morbidity, but we aim to compare postnatal creatinemia trends as a biomarker for subsequent cognitive outcome. We hypothesize that impaired microcirculation not only in the kidney, but also in general (i.e. brain development) can explain this possible link. Study designand outcome measures: A cohort of ELBW infants was analyzed byBayleyScalesofInfantDevelopment (BSID-II) at the corrected age of 2 years old. Besides other perinatal indicators, neonatal creatinemia trends of survivors (n = 140) and BSID scores (n = 96) are compared and analyzed using optimal matching analysis. Hierarchical clustering analysis is applied to identify createnimia trends. Results: Four different creatinemia trends were identified (persistently high, normal, low, high but normalizing). A low creatinemia trend is significantly associated with the lowest percentages of postnatal corticosteroids, NSAIDS and intraventricular hemorrhage (p = 0.005, p = 0.013 and p = 0.041 respectively) compared to a normal or persistently high creatinemia trend and associated with the best cognitive outcome (+13 points compared to the

Perinatal factors associated with long-term respiratory sequelae in extremely low birthweight infants

ObjectiveTo assess lung function at 8 years old in extremely low birthweight (ELBW) survivors and to identify perinatal determinants associated with impaired lung function.DesignRetrospective cohort study.SettingLevel III neonatal intensive care...

B-type natriuretic peptide and mortality in extremely low birth weight infants with pulmonary hypertension: a retrospective cohort analysis

BackgroundB-type natriuretic peptide (BNP) is a strong predictor of mortality in adult patients with various forms of pulmonary hypertension (PH) and may be a strong prognostic marker in extremely low birth weight (ELBW) infants with bronchopulmonary dysplasia (BPD) associated PH as well. We sought to assess the relationship between BNP levels and all-cause mortality in a cohort of ELBW infants with BPD and PH.MethodsWe retrospectively identified ELBW infants with BPD and PH who had serum BNP levels measured as part of routine clinical care in the neonatal intensive care unit. Peak serum BNP levels were correlated with survival to discharge or death.ResultsThirty-six ELBW infants (mean gestational age 26.0 ± 1.9 weeks and mean birth weight 740 ± 290 grams) with BPD and PH had available survival data and had serum BNP levels measured. Peak BNP level was significantly lower among infants who survived than among those who died (128 pg/ml, [IQR 23 to 463] vs. 997 pg/ml, [IQR 278 to 1770], P < 0.004). On multivariate Cox proportional hazard analysis, BNP predicted survival independent of age, gender, and BPD severity. Area under receiver operator characteristic analysis identified a BNP value of 220 pg/ml to have 90% sensitivity and 65% specificity in predicting mortality.ConclusionBNP estimation may be useful as a prognostic marker of all-cause mortality in ELBW infants with BPD associated PH.

Neurodevelopmental Outcome of Extremely Low Birth Weight Infants with Candida Infection

Candida remains an important cause of late-onset infection in preterm infants. Mortality and neurodevelopmental outcome of extremely low birth weight (ELBW) infants enrolled in the Candida study were evaluated based on infection status. ELBW infants born at Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NRN) centers between March 2004 and July 2007 who were screened for suspected sepsis were eligible for inclusion in the Candida study. Primary outcome data for neurodevelopmental impairment (NDI) or death were available for 1317 of the 1515 infants (87%) enrolled in the Candida study. The Bayley Scales of Infant Development-II or -III was administered at 18 months' adjusted age. A secondary comparison was performed with 864 infants enrolled in the NRN Generic Database during the same cohort who were never screened for sepsis and therefore not eligible for the Candida study. Among ELBW infants enrolled in the Candida study, 31% with Candida and 31% with late-onset non-Candida sepsis had NDI at 18 months. Infants with Candida sepsis and/or meningitis had an increased risk of death and were more likely to have the composite outcome of death and/or NDI compared with uninfected infants in adjusted analysis. Compared with infants in the NRN registry never screened for sepsis, overall risk for death were similar but those with Candida infection were more likely to have NDI (OR 1.83, 95% CI 1.01-3.33, P = .047). In this cohort of ELBW infants, those with infection and/or meningitis were at increased risk for death and/or NDI. This risk was highest among those with Candida sepsis and/or meningitis.

HIV Transmission to Extremely Low Birth Weight Infants

Prematurity increases the perinatal HIV transmission rate compared with term infants. There is sparse literature documenting the risk of transmission of HIV to extremely low birth weight (ELBW) infants. To determine the risk of perinatal transmission of HIV to ELBW infants in a tertiary neonatal unit in South Africa. A prospective database was maintained on all inborn ELBW infants over a 1-year period from March 2010 to February 2011. Survival and DNA HIV polymerase chain reaction results at 6 weeks were recorded. Of the 180 ELBW infants, 51 (28%) of these babies were HIV exposed. Of these 51 infants, 37 survived until 6 weeks of age. Polymerase chain reaction testing revealed 1 HIV-positive infant for a rate of 2.7% (95% confidence interval: 0.7-14.1%). Twenty-six (72%) of the 36 mothers received antiretroviral drugs, but only 16 (44%) had been treated for more than 1 month. The rate of HIV transmission in this cohort of ELBW infants is very low despite only 44% of the mothers receiving adequate antiretroviral drugs. We postulate that this is due to our high (89%) cesarean section rate, universal (100%) infant prophylactic antiretroviral drugs and the use of pasteurized breast milk.

Changes in Survival and Neonatal Morbidity in Infants with a Birth Weight of 750 g or Less

Background: Improvement in perinatal and neonatal care has resulted in increased survival of extremely low birth weight (ELBW) infants. Objectives: To describe survival and neonatal morbidity in a cohort of ELBW infants, to compare two consecutive 5-year periods, and compare appropriate (AGA) with small for gestational age (SGA) infants (AGA ≧p10, and SGA <p10). Methods: Retrospective cohort study of 179 live-born infants with a birth weight (BW) of ≤750 g and gestation of ≧24 weeks, born in 1996–2000 (cohort I, n = 94) and 2001–2005 (cohort II, n = 85) in theWilhelmina Children’s Hospital Utrecht, the Netherlands. Results: During NICU stay (n = 146) 62.3% experienced infant respiratory distress syndrome (IRDS), 46.6% bronchopulmonary dysplasia, 50.7% septicemia, 34.2% periventricular leukomalacia grade I and 24.7% intraventricular hemorrhage grade I/II. IRDS grade III/IV occurred significantly more often in cohort I (p = 0.042), whereas septicemia and hyperbilirubinemia occurred more in cohort II (p = 0.045 and p = 0.001). In AGA infants mean gestation was significantly shorter (p < 0.001), and IRDS grade III/IV (p = 0.015), mechanical ventilation (p = 0.045) and patent ductus arteriosus (p = 0.003) were significantly more prevalent. Overall survival was 62%, and survival in the NICU increased from 65.8% (cohort I) to 88.1% (cohort II, p = 0.002). Survival of AGA and SGA infants did not differ, but increased with time (71.4 to 75.9% and 61.4 to 97.4%, respectively). Conclusions: Mortality of infants with a BW of ≤750 g is high, but decreased over time, especially in SGA infants. Considerable neonatal morbidity was present, especially in AGA infants, most likely due to their significantly shorter gestation.

OUTCOME OF EXTREMELY LOW BIRTH WEIGHT INFANTS TREATED WITH SURFACTANT (CUROSURF) AND NASAL CONTINUOUS POSITIVE ARIWAY PRESSURE: A RETROSPECTIVE ANALYSIS.

Recent studies have shown a reduction in the need for mechanical ventilation in extremely low birth weight (ELBW) infants who are treated with surfactant followed by nasal continuous positive airway pressure (NCPAP). However, whether this therapy reduces the incidence of bronchopulmonary dysplasia (BPD) is uncertain. As we have been using this approach in ELBW infants we conducted a retrospective analysis using electronic data and hospital records of all infants at 500 to 1250 g who survived to 7 days of age from 1/5/2005 to 2/28/2006 (n = 84), of whom 68 infants (BW −0.91 ± 0.19 kg, GA 26 ± 2 weeks) met the criteria for inclusion. Infants who did not receive surfactant were excluded from the study. Time of intubation, dosing of surfactant, and time of first extubation were recorded. If infants required reintubation, the timing of first reintubation was recorded, as well as the time of final extubation. Patients were grouped by those extubated to high-flow nasal cannula, NCPAP, and those that required reintubation. Indication for reintubation was recorded. Outcome data were collected looking at oxygen need at 36 weeks adjusted age (BPD), death, as well as secondary outcomes, including IVH greater than grade 2, ROP, NEC, and PDA requiring treatment. The results are shown in the Table. Conclusion In our cohort of ELBW infants, 58% of infants did not require reintubation. In this group, the incidence of BPD was significantly reduced. Secondary outcomes (ROP, IVH, NEC) were statistically significant between the groups except for PDA and PDA treatment (Fisher9s exact test).

Rehospitalization of Extremely Low Birth Weight (ELBW) Infants: Are There Racial/Ethnic Disparities?

Premature infants are at increased risk for rehospitalization after discharge from the hospital. Racial disparities are known to exist in pediatric health care. To evaluate whether racial disparities exist in the proportion of extremely low birth weight (ELBW) infants rehospitalized prior to 18 months corrected age and the causes of rehospitalization. The National Institute of Child Health and Human Development Neonatal Research Network database was used to identify all ELBW infants (n=2446) who were born between November 1, 1998 and May 31, 2000 at the 14 participating centers and discharged alive (n=1591). Infants were seen at 18-22 months corrected age for followup. Data related to maternal variables, race, socioeconomic status, medical morbidities, insurance, and rehospitalizations were recorded from the medical record and parent interview. Logistic regression analyses were used to examine the relationship of race/ethnicity and rehospitalization while controlling for gestational age, gender, center, maternal education, family income, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis, ventriculoperitoneal (VP) shunt, respiratory syncytial virus (RSV) prophylaxis, and insurance type. In all, 1405 (88%) infants were evaluated at followup. The racial distribution of infants admitted, discharged, seen at followup, and rehospitalized were similar. Rehospitalization occurred at least once in 49% of the infants. In the logistic regression analyses, race was not a significant predictor for rehospitalization. The odds of rehospitalization were related to low family income, type of insurance, BPD, VP shunt, RSV prophylaxis, and center. Race was not a predominant variable in the risk of rehospitalization in this cohort of ELBW infants. Medical morbidities and low family income appear to be the major risk factors for rehospitalization.