Cohort Of VLBW Infants Research Articles

Optimal policies for nutrition administration to very low birth weight infants

AbstractVery low birth weight (VLBW) infants (birth weight 1500 grams) are at risk of postnatal growth restriction. Understanding how nutrition is associated with growth and how these associations vary based on infant characteristics and comorbidities is important to reduce postnatal growth restriction. We propose a three‐step analytical framework: (i) We use unsupervised Clustering techniques to identify subgroups within a cohort of VLBW infants based on infant characteristics, diagnoses, and treatments. (ii) For each cluster, we use Multilevel Modeling to explore the associations between calorie or protein intake and growth velocity (GV) for varying time windows. (iii) We build Mixed‐Integer Programming Models to achieve simple rule‐based policies that physicians can use to classify infants into one of the identified subgroups. We use electronic health records from VLBW infants at Lurie Children's Hospital in Chicago, IL, born between 2011 and 2014. We find that clustering separates infants into two clusters, with Cluster 1 having smaller infants with more comorbidities than Cluster 2. Initial clustering on only sex and birth weight provides results similar to clustering on later‐life diagnoses and treatments. Multilevel models with Clustering provide better model fit than models without clustering. For Cluster 1, there is a significant association between GV and protein but not calories. For Cluster 2, both protein and calories are individually associated with growth. We develop accurate and sparse scoring systems to help clinicians identify infants at higher risk of growth restriction and consider nutrition regimens accordingly.

Neurodevelopmental Outcome at 3 Years of Age in Very Low Birth Weight Infants According to Brain Development and Lesions.

During the last decades, severe brain lesions affecting very low birth weight (<1500 gr, VLBW) infants were gradually substituted by milder lesions with debatable prognoses. The objective of this study is to define type, frequency and 3 years of neurodevelopmental outcome of prematurity-related brain lesions in a modern cohort of VLBW infants. VLBW infants admitted to our NICU in 5 years period with brain MRI at term-equivalent age were included. MRI scans were reviewed to identify and grade white matter lesions (WML), intraventricular hemorrhage (IVH), and cerebellar hemorrhage (CBH). Linear measurements of brain size, biparietal width (BPW) and trans-cerebellar diameter (TCD) were carried out. Total maturation score (TMS) was calculated. Developmental Coefficients (DQ) on Griffiths Scale at 3 years of age were compared between patients with different types and grades of lesions and patients without lesions; possible correlations between linear brain measurements, brain maturation and outcome were explored. Study included 407 patients. Of them, 187 (46%) had at least one brain lesion on MRI, while 37 (9%) had severe lesions. The most frequent lesion was IVH (28%), followed by WML (21%) and CBH (17%). Mild and severe IVH, moderate and severe WML and all grades of CBH were related to worst outcome at 3 years. In patients without lesions, small BPW and small TCD were associated with worse outcomes. No correlations were observed between TMS and outcome. We have observed that even mild brain lesions have a negative influence on neurological outcome at 3 years of age.

Development and internal validation of a Neonatal Healthcare-associated infectiOn Prediction score (NeoHoP score) for very low birthweight infants in low-resource settings: a retrospective case–control study

Background and objectivesEarly diagnosis of neonatal infection is essential to prevent serious complications and to avoid unnecessary use of antibiotics. The prevalence of healthcare-associated infections (HAIs) among very low birthweight...

Racial/Ethnic Differences In The Prevalence Of Medical Complexity Or Death Among A National Cohort Of VLBW Infants

Racial/Ethnic Differences In The Prevalence Of Medical Complexity Or Death Among A National Cohort Of VLBW Infants

Early Use of Antibiotics Is Associated with a Lower Incidence of Necrotizing Enterocolitis in Preterm, Very Low Birth Weight Infants: The NEOMUNE-NeoNutriNet Cohort Study

To determine whether commencement of antibiotics within 3 postnatal days in preterm, very low birth weight (VLBW; ≤1500g) infants is associated with the development of necrotizing enterocolitis (NEC). Preplanned statistical analyses were done to study the association between early antibiotic treatment and later NEC development, using the NEOMUNE-NeoNutriNet cohort of VLBW infants from 13 neonatal intensive care units (NICUs) in 5 continents (n=2831). NEC incidence was compared between infants who received early antibiotics and those who did not, with statistical adjustments for NICU, gestational age, birth weight, sex, delivery mode, antenatal steroid use, Apgar score, and type and initiation of enteral nutrition. The incidence of NEC was 9.0% in the group of infants who did not receive early antibiotics (n=269), compared with 3.9% in those who did receive early antibiotics (n=2562). The incidence remained lower in the early antibiotic group after stepwise statistical adjustments for NICU (OR, 0.57; 95% CI, 0.35-0.94, P<.05) and other potential confounders (OR, 0.25; 95% CI, 0.12-0.47; P<.0001). In this large international cohort of preterm VLBW infants, a small proportion of infants did not receive antibiotics just after birth, and these infants had a higher incidence of NEC. It is important to better understand the role of such variables as time, type, and duration of antibiotic treatment on NEC incidence, immune development, gut colonization, and antibiotic resistance in the NICU.

Vision in former very low birthweight young adults with and without retinopathy of prematurity compared with term born controls: the NZ 1986 VLBW follow-up study

ObjectiveThere are few data on visual outcomes in adulthood of former very low birthweight (VLBW; <1500 g) infants. We aimed to assess vision at 27–29 years in a national cohort...

PC.44 Improved cognitive ability in preterm infants: The impact of a sepsis reduction care bundle

BackgroundVery low birth weight infants (VLBW; <1500 g) with late onset sepsis have an increased risk of neurodisability. Care bundles to reduce blood stream infections in NICU have been shown...

G211(P) Better cognitive outcomes for Very Low Birth Weight Infants after implementation of a sepsis reduction care bundle

BackgroundPublished data suggest that very low birth weight infants (VLBW; <1500 g) with late onset sepsis have increased risk of neurodisability. Care bundles to reduce blood stream infections in NICU...

Endogenous Stress Response on Pentatonic Music in Very Low Birthweight Infants

Background: Music exposition of prematures has previously been reported to reduce pain, improve vital signs and result in overall non-specific “well-being”. Valid data on endogenous stress hormone response to music, determined by salivary cortisol levels, are scarce. Objective: The aim of this study was to test the effect of live pentatonic music on the ambient stress level of very low birthweight infants. Methods: Stable infants (birthweight 500 - 1500 g, mean age: 22 days, n=16) were exposed to 15 minutes of live harp music on 3 consecutive days, at the same time of the day. Music was identically played on a kantele. Saliva was collected prior to music exposition and at defined time points after music. Salivary cortisol and cortisone levels were measured by liquid-chromatography-tandem-mass-spectrometry and salivary cortisol additionally by ELISA (n=10). Stress levels were additionally assessed by recordings of heart rate, respiratory rate and oxygen saturation. Pain level was determined by Bernese-Pain-Scale-for-Neonates (BSN). Results: Salivary cortisol decreased from baseline to 25 minutes and 4 hours after intervention on all 3 days (p < 0.05 on day 1 and 3). Apneas, the number of desaturations as well as BSN levels improved significantly on all 3 days (p< 0.05). Conclusion: Our findings indicate that pentatonic music exposition can decrease stress hormone levels of preterm neonates in a NICU environment. These are the first data regarding the effect of music exposition on stress hormone levels in a sufficient cohort of VLBW infants supporting a positive effect of music on these infants.

Postnatal Weight Changes in Very Low Birth Weight (VLBW) Infants - Comparison with Intrauterine and Postnatal Growth Grids

Background and objectives: The better providers understand growth of premature infants, more appropriate interventions can be developed to help these children to grow and develop. Controversy still exists whether growth of premature infants should be compared with intrauterine or longitudinal postnatal growth curves. We aimed to define the postnatal growth of premature infants and compare it with reference growth curves. Methods: We studied a prospective cohort of VLBW infants. Infants whose birth weight was < 10th centile, major neurological lesions and necrotizing enterocolitis ≥IIa were excluded. Weight was measured at five time points until 44 weeks postnatal age. Multiple comparisons were made between our postnatal weight gain and Ehrankranz's adequate for gestational age and Fenton's 50th centile weight growth curves, using Wilcoxon's test after Bonferroni's adjustment for multiple comparisons. Results: We studied 88 infants with a mean GA of 28,6 weeks and a mean birth weight of 1085g. Postnatal weight gain was statistically different from Fenton's 50th centile in all time points (p< 0,003). There was no difference when we compare our postnatal weigh growth with Ehrenkranz's curves except for infants with birth weight 701-900, 901-1100 and 1101-1300g, which had less weight at 13th postnatal day. Conclusions: Intrauterine growth curve were not appropriate for evaluation of postnatal weight gain of our cohort and confirms impression given by most authors that an adverse extrauterine environment prevents catch-up growth. Extrauterine postnatal curves proved to be more realistic and suitable to evaluate weight gain of premature infants.

Growth of a cohort of very low birth weight infants in Johannesburg, South Africa

BackgroundLittle is known about the growth of VLBW infants in South Africa. The aim of this study was to assess the growth of a cohort of VLBW infants in Johannesburg.MethodsA secondary analysis of a prospective cohort was conducted on 139 VLBW infants (birth weight ≤1500 g) admitted to Charlotte Maxeke Johannesburg Academic Hospital. Growth measurements were obtained from patient files and compared with the World Health Organization Child Growth Standards (WHO-CGS) and with a previous cohort of South African VLBW infants. The sample size per analysis ranged from 11 to 81 infants.ResultsComparison with the WHO-CGS showed initial poor growth followed by gradual catch up growth with mean Z scores of 0.0 at 20 months postmenstrual age for weight, -0.8 at 20 months postmenstrual age for length and 0.0 at 3 months postmenstrual age for head circumference. Growth was comparable with that of a previous cohort of South African VLBW infants in all parameters.ConclusionsInitial poor growth in the study sample was followed by gradual catch up growth but with persistent deficits in length for age at 20 months postmenstrual age relative to healthy term infants.

Racial disparities in health-related quality of life in a cohort of very low birthweight 2- and 3-year-olds with and without cerebral palsy

We examine racial differences in health-related quality of life (HRQoL) among 2- and 3-year-olds born very low birthweight (VLBW, <1500 g). The sample included 611 children (290 males and 321 females) from the Newborn Lung Project, a cohort of VLBW infants hospitalized in Wisconsin's newborn intensive care units during 2003 to 2004. Of the 611 children, 14% (86/611) were black, non-Hispanic and 86% (525/611) were white, non-Hispanic and 4% (23/611) had cerebral palsy. HRQoL was measured using the Pediatric Quality of Life Inventory. Black children scored nearly four points lower (mean difference -3.6, 95% confidence interval [CI]: -6.9 to -0.3) on HRQoL than their white peers. Cerebral palsy is associated with lower HRQoL (mean difference -24.4, 95% CI: -29.3 to -19.5), especially among black children, but does not explain racial differences in HRQoL. Living in a neighborhood with lowest levels of female education is associated with lower HRQoL (mean difference -5.6, 95% CI: -9.2 to -2.1), but does not explain the racial difference in HRQoL.

598 Vlbw Infants: Accelerated Cognitive Development at Two Years

There is a paucity of literature concentrating on the VLBW infant whose development is accelerated. This study addresses a cohort of Infants BW ≤ 1500g who had high Bayley Mental Developmental scores (≥115).Methods: VLBW ≤1500g born in a tertiary 3 Unit were followed up at 2 years corrected age. The Bayley Scales of Infant Development - 11 were used to measure Mental, Psychomotor and Emotional development during the period 1997- 2004.Results: Of 460 infants assessed 73 (15.7%) infants demonstrated Accelerated Mental Performance (MDI ≥ 115). 70% were girls; 30% boys. Linguistic acquisition was a strong feature. Birthweight and Gestational age did not influence outcome. A subtask analysis was performed. 25 tasks consisting of cognitive, language and visual spatial skills were identified. Of these 25 tasks, 56% (14 tasks) of the Accelerated group demonstrated >90% success whereas only 8% (2 tasks) of the Normal Outcome group demonstrated >90% success. Tasks that were most discriminatory in showing a difference between the Accelerated group and the Normal Outcome group were shape discrimination, use of 3 word and contingent utterances, picture naming, picture discrimination, and tower building. Attention skills, task planning and prompt performance were strong features in the Accelerated group.Conclusion: 16% of our cohort of VLBW infants achieved accelerated performance on the Bayley scale when tested at 2 years. We identified specific tasks that discriminated the performance of the Accelerated group from the Normal group and noted favourable behavioural characteristics that were integral to higher level of task performance.

Use of Central Venous Catheter and Peripheral Venous Catheter as Risk Factors for Nosocomial Bloodstream Infection in Very-Low-Birth-Weight Infants

To describe the relationship between the use of central and peripheral venous catheters and the risk of nosocomial, primary, laboratory-confirmed bloodstream infection (BSI) for neonates with a birth weight less than 1,500 g (very-low-birth-weight [VLBW] infants). Cox proportional hazard regression analysis with time-dependent variable was used to determine the risk factors for the occurrence of BSI in a cohort of VLBW infants. We analyzed previously collected surveillance data from the German national nosocomial surveillance system for VLBW infants. All VLBW infants in 22 participating neonatal departments who had a complete daily record of patient information were included. Of 2,126 VLBW infants, 261 (12.3%) developed a BSI. The incidence density for BSI was 3.3 per 1,000 patient-days. The multivariate analysis identified the following significant independent risk factors for BSI: lower birth weight (hazard ratio [HR], 1.1-2.2), vaginal delivery (HR, 1.5), central venous catheter use (HR, 6.2) or peripheral venous catheter use (HR, 6.0) within 2 days before developing BSI, and the individual departments (HR, 0.0-4.6). After adjusting for other risk factors, use of peripheral venous catheter and use of central venous catheter were significantly related to occurrence of BSI in VLBW infants.

Very low birthweight and asthma by age seven years in a national cohort.

Several studies have suggested that very low birthweight (VLBW < 1500 g) is associated with increased rates of respiratory problems in childhood and that the presence of chronic lung disease further increases the risk. We aimed to assess rates of asthma at 7-8 years of age in a national cohort of VLBW infants born in 1986 and for whom perinatal data were available. Two hundred ninety-nine former VLBW children (96% of surviving children living in New Zealand) were assessed at a home visit. Parents were asked a comprehensive questionnaire, including three questions aimed at assessing morbidity from asthma: 1) was the child diagnosed as having asthma before age 7 years; 2) was the child still experiencing asthma at the age of 7 years; and 3) was the child prescribed daily medication for asthma at the age of 7 years. Overall, 50% of the cohort had been diagnosed with asthma before age 7, compared with 27% of a sample of New Zealand children assessed contemporaneously in an international study; 32% had asthma at age 7, and 11% were taking daily medication. All three categories of asthma were associated with a family history of asthma, but there was no association with any perinatal factors. A diagnosis of asthma before age 7 was more likely when the mother smoked in pregnancy (P < 0.005) and currently smoked (P < 0.01), and trended so when parents lacked high school qualifications and in Maori or Pacific Island families (P < 0.10). In contrast, daily medication was more frequent when parents had educational qualifications and in non-Maori or Pacific Island families (P < 0.05). On multiple logistic regression, a family history of asthma was a significant predictor for any and current asthma (P < 0.001) and daily medication (P < 0.05); maternal smoking in pregnancy was a significant predictor for any asthma (P < 0.05); and non-Maori or Pacific Island ethnicity was a significant predictor for asthma treatment (P < 0.05). We conclude that rates of childhood asthma are high in this VLBW cohort, but the high prevalence appears to be unrelated to perinatal factors, including respiratory morbidity. There are suggestions that social factors contribute to both asthma risk and treatment.

Receipt of Breast Milk and Subsequent Cognitive Ability at 7-8 Years amongst a National Cohort of VLBW Infants • 1233

Receipt of Breast Milk and Subsequent Cognitive Ability at 7-8 Years amongst a National Cohort of VLBW Infants • 1233